De novo variants in the non-coding spliceosomal snRNA gene RNU4-2 are a frequent cause of syndromic neurodevelopmental disorders.

Around 60% of individuals with neurodevelopmental disorders (NDD) remain undiagnosed after comprehensive genetic testing, primarily of protein-coding genes1. Increasingly, large genome-sequenced cohorts are improving our ability to discover new diagnoses in the non-coding genome. Here, we identify the non-coding RNA RNU4-2 as a novel syndromic NDD gene. RNU4-2 encodes the U4 small nuclear RNA (snRNA), which is a critical component of the U4/U6.U5 tri-snRNP complex of the major spliceosome2. We identify an 18 bp region of RNU4-2 mapping to two structural elements in the U4/U6 snRNA duplex (the T-loop and Stem III) that is severely depleted of variation in the general population, but in which we identify heterozygous variants in 119 individuals with NDD. The vast majority of individuals (77.3%) have the same highly recurrent single base-pair insertion (n.64_65insT). We estimate that variants in this region explain 0.41% of individuals with NDD. We demonstrate that RNU4-2 is highly expressed in the developing human brain, in contrast to its contiguous counterpart RNU4-1 and other U4 homologs, supporting RNU4-2's role as the primary U4 transcript in the brain. Overall, this work underscores the importance of non-coding genes in rare disorders. It will provide a diagnosis to thousands of individuals with NDD worldwide and pave the way for the development of effective treatments for these individuals.

Cost, energy, and carbon footprint benefits of second-life electric vehicle battery use.

The manuscript reviews the research on economic and environmental benefits of second-life electric vehicle batteries (EVBs) use for energy storage in households, utilities, and EV charging stations. Economic benefits depend heavily on electricity costs, battery costs, and battery performance; carbon benefits depend largely on the electricity mix charging the batteries. Environmental performance is greatest when used to store renewable energy such as wind and solar power. Inconsistent system boundaries make it challenging to compare the life cycle carbon footprint across different studies. The future growth of second-life EVB utilization faces several challenges, including the chemical and electrical properties and states of health of retired EVBs, the rapidly decreasing costs of new batteries, and different operational requirements. Measures to mitigate these challenges include the development of efficient diagnostic technologies, comprehensive test standards, and battery designs suitable for remanufacturing. Further research is needed based on real-world operational data and harmonized approaches.

Cradle-to-Gate and Use-Phase Carbon Footprint of a Commercial Plug-in Hybrid Electric Vehicle Lithium-Ion Battery.

Increased use of vehicle electrification to reduce greenhouse gas (GHG) emissions has led to the need for an accurate and comprehensive assessment of the carbon footprint of traction batteries. Unfortunately, there are few lifecycle assessments (LCAs) of commercial lithium-ion batteries available in the literature, and those that are available focus on the cradle-to-gate stage, often with little or no consideration of the use phase. To address this shortfall, we report both cradle-to-gate and use-phase GHG emissions for the 2020 Model Year Ford Explorer plug-in hybrid electric vehicle (PHEV) NMC622 battery. Using primary industry data for battery design and manufacturing, cradle-to-gate emissions are estimated to be 1.38 t CO2e (101 kg CO2e/kWh), with 78% from materials and parts production and 22% from cell, module, and pack manufacturing. Using mass-induced energy consumptions of 0.6 and 1.6 kWh/(100 km 100 kg) for charge-depleting and -sustaining modes, respectively, the mass-induced use-phase emission of the battery is estimated to be 1.04 t CO2e. We show that battery emissions during the cradle-to-gate and use phases are comparable and that both phases need to be considered. A holistic and harmonized LCA approach that includes battery use is required to reduce carbon footprint uncertainties and guide future battery designs.

Propensity score matching analysis of perioperative outcomes including quality of life after multi-port vs. single port laparoscopic cholecystectomy: a nationwide prospective multicenter study in Korea.

INTRODUCTION: The usefulness of single-port laparoscopic cholecystectomy (SPLC) as compared to multi-port laparoscopic cholecystectomy (MPLC) remains controversial. Between SPLC and MPLC, we compared outcomes, especially subjective aspects, such as quality of life (QoL). MATERIAL AND METHODS: This multi-center study, involving 20 institutions from 2016 to 2017, enrolled 2507 patients who underwent laparoscopic cholecystectomy. Various perioperative outcomes, pain assessed by the numeric rating scale (NRS) score, and QoL evaluated by the gastrointestinal QoL index (GIQLI) questionnaire, were compared between the two procedures. We generated balanced groups after propensity score matching (PSM) using preoperative factors that influence the decision to perform MPLC or SPLC. RESULTS: MPLC and SPLC were performed in 2176 and 331 patients, respectively. Nine hundred and twelve and 329 patients, respectively, were selected from the two groups by PSM. Operation time was longer and surgical difficulty was lower in SPLC. There were no significant differences in most outcomes, including biliary complications. Significant superiority of SPLC over MPLC was shorter hospitalization, lower NRS score, and favorable GIQLI. CONCLUSIONS: From nationwide prospective data, SPLC showed outcomes comparable to MPLC. In SPLC, morbidity was not high and postoperative QoL was favorable. In the future, more implementations and studies are needed to ensure the safety and feasibility of SPLC.

Carbon Footprint of Alternative Grocery Shopping and Transportation Options from Retail Distribution Centers to Customer.

The COVID-19 pandemic has accelerated the growth of e-commerce and automated warehouses, vehicles, and robots and has created new options for grocery supply chains. We report and compare the greenhouse gas (GHG) emissions for a 36-item grocery basket transported along 72 unique paths from a centralized warehouse to the customer, including impacts of micro-fulfillment centers, refrigeration, vehicle automation, and last-mile transportation. Our base case is in-store shopping with last-mile transportation using an internal combustion engine (ICE) SUV (6.0 kg CO2e). The results indicate that emissions reductions could be achieved by e-commerce with micro-fulfillment centers (16-54%), customer vehicle electrification (18-42%), or grocery delivery (22-65%) compared to the base case. In-store shopping with an ICE pick-up truck has the highest emissions of all paths investigated (6.9 kg CO2e) while delivery using a sidewalk automated robot has the least (1.0 kg CO2e). Shopping frequency is an important factor for households to consider, e.g. halving shopping frequency can reduce GHG emissions by 44%. Trip chaining also offers an opportunity to reduce emissions with approximately 50% savings compared to the base case. Opportunities for grocers and households to reduce grocery supply chain carbon footprints are identified and discussed.

Cell-Type-Specific Expression of Hyaluronan Synthases HAS2 and HAS3 Promotes Goblet Cell Hyperplasia in Allergic Airway Inflammation.

Allergic rhinitis (AR) is a multifactorial airway disease characterized by basal and goblet cell hyperplasia. Hyaluronic acid (HA) is a major component of extracellular matrix and a critical contributor to tissue repair and remodeling after injury. We previously demonstrated that the intermediate progenitor cell (IPC) surface marker CD44v3 is upregulated in the basal and suprabasal layers of well-differentiated primary human nasal epithelial (HNE) cells after stimulation with the Th2 (T-helper cell type 2) cytokine IL-4, and an antibody blocking the CD44v3-HA interaction suppressed IL-4-induced goblet cell hyperplasia. We now show that the expression of HA and two HA synthases, HAS2 and HAS3, was upregulated in both the nasal surface epithelium of subjects with AR and IL-4-stimulated HNE cells. Inhibition of HA synthesis by 4-methylumbelliferone suppressed IL-4-induced goblet cell hyperplasia. Moreover, HAS2 and HAS3 were expressed in IPCs depending on the differentiation events, as follows: the rapid, transient upregulation of HAS2 induced basal IPC proliferation and basal-to-suprabasal transition, whereas the delayed upregulation of HAS3 promoted the transition of suprabasal IPCs to a goblet cell fate. 4-methylumbelliferone treatment in a house dust mite-induced murine AR model attenuated goblet cell metaplasia. Last, HA concentrations in nasal epithelial lining fluids from patients with AR positively correlated with the concentrations of mediators causing allergic inflammation. These data suggest that HA produced after the sequential upregulation of HAS2 and HAS3 contributes to goblet cell hyperplasia in allergic airway inflammation and modulates disease progression.

Effect of Bacillus subtilis Zeolite Used for Sediment Remediation on Sulfide, Phosphate, and Nitrogen Control in a Microcosm.

Eutrophication is an emerging worldwide issue concerning the excessive accumulation of various pollutants in sediments, owing to the release of industrial or household wastewaters to coastal areas. The coastal sediment of Goseong Bay in the Republic of Korea is organically enriched with pollutants, including heavy metals, sulfide, phosphate, and ammonia. Microbial remediation and capping techniques have been suggested as effective routes for sediment remediation. In this study, Bacillus subtilis zeolite (BZ) was used as a sediment capping material, and effective remediation of coastal sediment was observed in a 40-day laboratory microcosm experiment. A significant decrease in the sediment water content and reduced concentration of acid volatile sulfide were observed in the BZ-capped sediment. In the overlying water and pore water, significant decreases in phosphate and dissolved inorganic nitrogen (DIN; NO2-N + NO3-N and NH4-N) concentrations were observed in the BZ-treated experiment. Based on our findings, we conclude that BZ could be an effective capping material for coastal sediment remediation.

LncRNAs Are Differentially Expressed between Wildtype and Cell Line Strains of African Trypanosomes.

Trypanosoma brucei is a parasitic protist that causes African sleeping sickness. The establishment of T. brucei cell lines has provided a significant advantage for the majority of T. brucei research. However, these cell lines were isolated and maintained in culture for decades, occasionally accumulating changes in gene expression. Since trypanosome strains have been maintained in culture for decades, it is possible that difference may have accumulated in fast-evolving non-coding RNAs between trypanosomes from the wild and those maintained extensively in cultures. To address this, we compared the lncRNA expression profile of trypanosomes maintained as cultured cell lines (CL) to those extracted from human patients, wildtype (WT). We identified lncRNAs from CL and WT from available transcriptomic data and demonstrate that CL and WT have unique sets of lncRNAs expressed. We further demonstrate that the unique and shared lncRNAs are differentially expressed between CL and WT parasites, and that these lncRNAs are more evenly up-regulated and down-regulated than protein-coding genes. We validated the expression of these lncRNAs using qPCR. Taken together, this study demonstrates that lncRNAs are differentially expressed between cell lines and wildtype T. brucei and provides evidence for potential evolution of lncRNAs, specifically in T. brucei maintained in culture.

Multiomic analysis of Schistosoma mansoni reveals unique expression profiles in cercarial heads and tails.

Schistosomes require both molluscan and mammalian hosts for development. The larval cercaria exits the snail host and swims to identify and invade the mammalian host. The cercaria has two macrostructures, the head and the tail. The head invades the host, where it matures into an adult worm. The tail is lost after host invasion. Translation in the cercaria differs in each macrostructure, with higher levels of translation in the cercarial tail and little to no translational activity in the cercarial head. We compared the transcriptome and proteome of the cercarial head and tail and observed stark differences between the two macrostructures. We identified unique and differentially expressed transcripts and proteins, including ribosomal components expressed in higher levels in tails than in heads, which may explain the differences in translation levels between heads and tails. We also characterized the weak correlation between transcription and translation in infectious cercarial heads and tails.

Characterizing the Changes in Material Use due to Vehicle Electrification.

Modern automobiles are composed of more than 2000 different compounds comprising 76 different elements. Identifying supply risks across this palette of materials is important to ensure a smooth transition to more sustainable transportation technologies. This paper provides insight into how electrification is changing vehicle composition and how that change drives supply risk vulnerability by providing the first comprehensive, high-resolution (elemental and compound level) snapshot of material use in both conventional and hybrid electric vehicles (HEVs) using a consistent methodology. To make these contributions, we analyze part-level data of material use for seven current year models, ranging from internal combustion engine vehicles (ICEV) to plug-in hybrid vehicles (PHEVs). With this data set, we apply a novel machine learning algorithm to estimate missing or unreported composition data. We propose and apply a metric of vulnerability, referred to as exposure, which captures economic importance and susceptibility to price changes. We find that exposure increases from $874 per vehicle for ICEV passenger vehicles to $2344 per vehicle for SUV PHEVs. The shift to a PHEV fleet would double automaker exposure adding approximately $1 billion per year of supply risk to a hypothetical fleet of a million vehicles. The increase in exposure is largely not only due to the increased use of battery elements like cobalt, graphite, and nickel but also some more commonly used materials, most notably copper.

Life Cycle Greenhouse Gas Emissions for Last-Mile Parcel Delivery by Automated Vehicles and Robots.

Increased E-commerce and demand for contactless delivery during the COVID-19 pandemic have fueled interest in robotic package delivery. We evaluate life cycle greenhouse gas (GHG) emissions for automated suburban ground delivery systems consisting of a vehicle (last-mile) and a robot (final-50-feet). Small and large cargo vans (125 and 350 cubic feet; V125 and V350) with an internal combustion engine (ICEV) and battery electric (BEV) powertrains were assessed for three delivery scenarios: (i) conventional, human-driven vehicle with human delivery; (ii) partially automated, human-driven vehicle with robot delivery; and (iii) fully automated, connected automated vehicle (CAV) with robot delivery. The robot's contribution to life cycle GHG emissions is small (2-6%). Compared to the conventional scenario, full automation results in similar GHG emissions for the V350-ICEV but 10% higher for the V125-BEV. Conventional delivery with a V125-BEV provides the lowest GHG emissions, 167 g CO2e/package, while partially automated delivery with a V350-ICEV generates the most at 486 g CO2e/package. Fuel economy and delivery density are key parameters, and electrification of the vehicle and carbon intensity of the electricity have a large impact. CAV power requirements and efficiency benefits largely offset each other, and automation has a moderate impact on life cycle GHG emissions.

Influence of intensive net cage farming on hydrodynamic and geochemical environmental conditions and the mass mortality of abalone in South Korea.

The abalone aquaculture industry in South Korea has grown rapidly since the 2000s. In this study, we investigated the sedimentary pollution at four major abalone farms responsible for ~60% of all South Korean abalone produced. We also surveyed the current statuses of cage facilities, abalone mass mortality, and current velocities within and outside farm cages. The concentrations of total organic carbon in the study area were 7.92 ± 2.09 mg g-1, indicating a mild level of sedimentary pollution. We observed higher mortality rates in rectangular-shaped shelter cages than in triangular shelters. With increases in the number and size of abalone farming facilities, current velocities inside the cages declined by an average of 45% relative to those outside the cages, leading to poor habitat conditions for farmed abalone. Our results provide insights into the current status of the benthic environments and major causes of mass mortality in the abalone farms of South Korea.

Identification of Monoallelically Expressed Genes Associated with Economic Traits in Hanwoo (Korean Native Cattle).

Hanwoo, an indigenous Korean cattle breed, has been genetically improved by selecting superior sires called Korean-proven bulls. However, cows still contribute half of the genetic stock of their offspring, and allelic-specific expressed genes have potential, as selective targets of cows, to enhance genetic gain. The aim of this study is to identify genes that have MAEs based on both the genome and transcriptome and to estimate their effects on breeding values (BVs) for economically important traits in Hanwoo. We generated resequencing data for the parents and RNA-sequencing data for the muscle, fat, and brain tissues of the offspring. A total of 3801 heterozygous single nucleotide polymorphisms (SNPs) in offspring were identified and they were located in 1569 genes. Only 14 genes showed MAE (seven expressing maternal alleles and seven expressing paternal alleles). Tissue-specific MAE was observed, and LANCL1 showed maternal allele expression across all tissues. MAE genes were enriched for the biological process of cell death and angiogenesis, which included ACKR3 and PDCL3 genes, whose SNPs were significantly associated with BVs of lean meat production-related traits, such as weight at 12 months of age, carcass weight, and loin eye area. In the current study, monoallelically expressed genes were identified in various adult tissues and these genes were associated with genetic capacity in Hanwoo.

CD44v3-Positive Intermediate Progenitor Cells Contribute to Airway Goblet Cell Hyperplasia.

In allergic airway diseases, intermediate progenitor cells (IPCs) increase in number in the surface epithelium. IPCs arise from basal cells, the origin of hallmark pathological changes, including goblet cell hyperplasia and mucus hypersecretion. Thus, targeting IPCs will benefit future treatment of allergic airway diseases. However, the lack of adequate cell surface markers for IPCs limits their identification and characterization. We now show that CD44 containing exon v3 (CD44v3) is a surface marker for IPCs that are capable of both proliferating and generating differentiated goblet cells in allergic human nasal epithelium. In primary human nasal epithelial cells that had differentiated at an air-liquid interface, IL-4 upregulated mRNA expression of three CD44v variants that include exon v3 (CD44v3-v6, CD44v3,v8-v10, and CD44v3-v10), and it induced expression of CD44v3 protein in the basal and suprabasal layers of the culture. FACS analysis revealed two subpopulations differing in CD44v3 concentrations, as follows: CD44v3low cells expressed high amounts of proliferative and basal cell markers (Ki-67 and TP63), whereas CD44v3high cells strongly expressed progenitor and immature and mature goblet cell markers (SOX2, CA2, and SPDEF). Importantly, a blocking anti-CD44 antibody suppressed IL-4-induced mucin production by human nasal epithelial cells. Furthermore, CD44v3 was coexpressed with TP63, KRT5, or SOX2 and was upregulated in the basal and suprabasal layers of the nasal surface epithelium of subjects with allergic rhinitis. Taken together, these data demonstrate that high CD44v3 expression contributes to goblet cell hyperplasia in inflammation of the allergic airway.

Evaluating the cost and carbon footprint of second-life electric vehicle batteries in residential and utility-level applications.

The volume of end-of-life automotive batteries is increasing rapidly as a result of growing electric vehicle adoption. Most automotive lithium-ion batteries (LIBs) are recycled but could be repurposed as second-life batteries (SLBs) since they have 70-80% residual capacity, which can be adequate for stationary applications. SLBs have been proposed as potential, inexpensive, low-carbon energy storage for residential and utility-level applications, with or without photovoltaics (PV). However, it is unknown whether SLBs will be better than new batteries and whether SLBs will provide similar cost and carbon emission reduction for the different stationary applications in all locations. This work compared the levelized cost of electricity and life-cycle carbon emissions associated with using SLBs and new LIBs in the US for three energy storage applications: (1) residential energy storage with rooftop PV, (2) utility-level PV firming, and (3) utility-level peak-shaving, leading to a total of 41 scenarios. SLBs reduced the levelized cost of electricity by 12-57% and carbon emissions by 7-31% compared to new LIBs in the considered applications, with higher reductions for utility-level applications. SLBs still provided benefits at the residential level when compared to rooftop PV alone by reducing the levelized cost by 15-25% and carbon emissions by 22-51%, making SLBs attractive to residential consumers as well. SLBs offer an opportunity to utilize an end-of-life product for energy storage applications, provided the uncertainty in SLB quality and availability is addressed.

Economic and Environmental Feasibility of Second-Life Lithium-Ion Batteries as Fast-Charging Energy Storage.

Energy storage can reduce peak power consumption from the electricity grid and therefore the cost for fast-charging electric vehicles (EVs). It can also enable EV charging in areas where grid limitations would otherwise preclude it. To address both the need for a fast-charging infrastructure as well as management of end-of-life EV batteries, second-life battery (SLB)-based energy storage is proposed for EV fast-charging systems. The electricity grid-based fast-charging configuration was compared to lithium-ion SLB-based configurations in terms of economic cost and life cycle environmental impact in five U.S. cities. Compared to using new batteries, SLB reduced the levelized cost of electricity (LCOE) by 12-41% and the global warming potential (GWP) by 7-77%. Photovoltaics along with SLB reduced the use of grid electricity and provided higher GWP and cumulative energy demand (CED) reduction compared to only using SLB. The LCOE of the SLB-based configurations was sensitive to SLB cost, lifetime, efficiency, and discount rate, whereas the GWP and CED were affected by SLB lifetime, efficiency, and the required enclosure materials. Solar insolation and electricity pricing structures were key in determining the configuration, which was economically and environmentally suitable for a location.

LncRNAs in molluscan and mammalian stages of parasitic schistosomes are developmentally-regulated and coordinately expressed with protein-coding genes.

Despite the low level expression of some long noncoding RNAs (lncRNAs), the differential expression of specific lncRNAs plays important roles during the development of many organisms. Schistosomes, parasitic flatworms that are responsible for schistosomiasis, infects over 200 million people resulting in chronic disease and hundreds of thousands of deaths. Schistosomes have a complex life cycle that transitions between molluscan and mammalian hosts. In a molluscan snail host, the sporocyst stage develops over 5 weeks undergoing asexual reproduction to give rise to free-swimming and infectious cercariae that penetrate human skin and eventually mature into egg producing worms in mammals. The tight integration of the sporocyst to the snail host hepatopancreas hinders the -omics study in the molluscan stage, so the sporocyst transcriptome has only been examined for lncRNAs in immature in vitro samples. Here we analyzed the in vivo mature sporocyst transcriptome to identify 4,930 total lncRNAs between the molluscan and mammalian stages of the parasite. We further demonstrate that the lncRNAs are differentially expressed in a development-dependent manner. In addition, we constructed a co-expression correlation network between lncRNAs and protein-coding (PC) genes that was used to identify clusters of lncRNA transcripts with potential functional relevance. We also describe lncRNA-lncRNA and lncRNA-kinome correlations that identify lncRNAs with prospective roles in gene regulation. Finally, our results show clear differential expression patterns of lncRNAs in host-dependent development stages of S. mansoni and ascribe potential functional roles in development based on predicted intracellular interaction.

Regional Heterogeneity in the Emissions Benefits of Electrified and Lightweighted Light-Duty Vehicles.

Electrification and lightweighting technologies are important components of greenhouse gas (GHG) emission reduction strategies for light-duty vehicles. Assessments of GHG emissions from light-duty vehicles should take a cradle-to-grave life cycle perspective and capture important regional effects. We report the first regionally explicit (county-level) life cycle assessment of the use of lightweighting and electrification for light-duty vehicles in the U.S. Regional differences in climate, electric grid burdens, and driving patterns compound to produce significant regional heterogeneity in the GHG benefits of electrification. We show that lightweighting further accentuates these regional differences. In fact, for the midsized cars considered in our analysis, model results suggest that aluminum lightweight vehicles with a combustion engine would have similar emissions to hybrid electric vehicles (HEVs) in about 25% of the counties in the US and lower than battery electric vehicles (BEVs) in 20% of counties. The results highlight the need for a portfolio of fuel efficient offerings to recognize the heterogeneity of regional climate, electric grid burdens, and driving patterns.

Role of flying cars in sustainable mobility.

Interest and investment in electric vertical takeoff and landing aircraft (VTOLs), commonly known as flying cars, have grown significantly. However, their sustainability implications are unclear. We report a physics-based analysis of primary energy and greenhouse gas (GHG) emissions of VTOLs vs. ground-based cars. Tilt-rotor/duct/wing VTOLs are efficient when cruising but consume substantial energy for takeoff and climb; hence, their burdens depend critically on trip distance. For our base case, traveling 100 km (point-to-point) with one pilot in a VTOL results in well-to-wing/wheel GHG emissions that are 35% lower but 28% higher than a one-occupant internal combustion engine vehicle (ICEV) and battery electric vehicle (BEV), respectively. Comparing fully loaded VTOLs (three passengers) with ground-based cars with an average occupancy of 1.54, VTOL GHG emissions per passenger-kilometer are 52% lower than ICEVs and 6% lower than BEVs. VTOLs offer fast, predictable transportation and could have a niche role in sustainable mobility.

Preoperative neutrophil-lymphocyte ratio and CEA is associated with poor prognosis in patients with synchronous colorectal cancer liver metastasis.

PURPOSE: Recently, the neutrophil-to-lymphocyte ratio (NLR), an inflammatory response marker, has been reported to be associated with the prognosis in patients with various type of cancer. However, there have been no studies until now that have explored the prognostic role of combined detection of NLR and CEA in patients with synchronous liver-limited colorectal metastases (sCRLM). METHODS: Eighty-three patients who histologically diagnosed as sCRLM were selected. Their laboratory and clinical data were collected retrospectively. Using receiver operating characteristic curve analysis, the cutoff value of NLR was calculated based on which patients were assigned to a high NLR (more than 1.94) group and low NLR (less than 1.94) group. A cutoff value of 100 ng/mL for serum CEA level was used in light of the previous literature. RESULTS: CEA level and Poorly differentiated histology of colon cancer was significantly correlated with high NLR (P = 0.005 and P = 0.048, respectively). The multivariate analysis identified the high NLR as independent prognostic factors for OS and DFS in all patients (P = 0.010 and P = 0.006, respectively). Patients with both low levels of NLR and CEA had a significantly longer OS and DFS (P = 0.026 and P = 0.009, respectively). CONCLUSION: In conclusion, elevated preoperative NLR is strongly correlated with both survival and recurrence in patients who have been diagnosed with resectable sCRLM. The combination of NLR and CEA level could be a more powerful prognostic marker than NLR alone.