Factors affecting do-not-attempt-resuscitation (DNAR) decisions among adult patients in the emergency department of a general tertiary teaching hospital in China: a retrospective observational study.

OBJECTIVE: Do-not-attempt-resuscitation (DNAR) orders are designed to allow patients to opt out of receiving cardiopulmonary resuscitation in the event of a cardiac arrest. While DNAR has become a standard component of medical care, there is limited research available specifically focusing on DNAR orders in the context of emergency departments in China. This study aimed to fill that gap by examining the factors related to DNAR orders among patients in the emergency department of a general tertiary teaching hospital in China. DESIGN: Retrospective observational study. SETTING: Emergency department. PARTICIPANTS: This study and analysis on adult patients with DNAR or no DNAR data between 1 January 2022 and 1 January 2023 in the emergency department of a large academic comprehensive tertiary teaching hospital. A total of 689 were included in our study. PRIMARY OUTCOME MEASURES: Whether the patient received DNAR was our dependent variable. RESULTS: Among the total patients, 365 individuals (53.0%) had DNAR orders. The following variables, including age, sex, age-adjusted Charlson comorbidity index (ACCI), primary diagnosis of cardiogenic or cancer related, history of neurological dysfunction or cancer, were independently associated with the difference between the DNAR group and the no DNAR group. Furthermore, there were significant statistical differences observed in the choice of DNAR among patients with different stages of cancer. CONCLUSIONS: In comparison to the no DNAR group, patients with DNAR were characterised by being older, having a higher proportion of female patients, higher ACCI scores, a lower number of patients with a primary diagnosis of cardiogenic and a higher number of patients with a primary diagnosis of cancer related, history of neurological dysfunction or cancer.

Collagen changes in rabbit conjunctiva after conjunctival crosslinking.

This study aims to determine the ultrastructural changes in collagen fibrils in rabbit conjunctiva after conjunctival crosslinking using riboflavin and ultraviolet A (UVA) light at an irradiation intensity of 45 mW/cm2. Conjunctival crosslinking may increase conjunctival stiffness. The supertemporal quadrants of the right eyes of 24 adult rabbits were treated with a topical riboflavin solution (0.25%) before irradiation with UVA light at 45 mW/cm2 for 4 min. After 3 weeks, the collagen fibrils in fibril bundles were examined by electron microscopy. Immunohistochemical staining was used to detect the expression levels of collagen I and collagen III in the rabbits' conjunctiva. The diameter of the collagen fibrils in the fibril bundles varied slightly, ranging from 30 to 60 nm in the conjunctival stroma of the control group. In the treatment group, the diameter of collagen fibrils ranged from 60 to 90 nm. The thickest collagen fibrils were observed in the treatment group (up to 90 nm in diameter). In contrast, those in the conjunctival stroma of the control group were considerably smaller (up to 60 nm in diameter). However, thicknesses of collagen fibrils displayed a unimodal distribution. Both collagen I and collagen III increased after treatment with riboflavin and UVA light irradiation at 45 mW/cm2. The data indicate that in rabbits, conjunctival crosslinking with riboflavin and UVA light at 45 mW/cm2 for 4 min is safe and does not induce ultrastructural alterations of the conjunctival cells. The conjunctival crosslinking with riboflavin and UVA light at 45 mW/cm2 can increase the diameter of collagen fibrils, but the average densities of collagen I and collagen III have no statistical significance.

The Promoter SNPs Were Associated with Both the Contents of Poly-Unsaturated Fatty Acids (PUFAs) and the Expressions of PUFA-Related Genes in Common Carp.

The allo-tetraploid common carp encodes two duplicated fads2 genes (fads2a and fads2b) and two duplicated elovl5 genes (elovl5a and elovl5b). The coding SNPs (cSNPs) of these genes were reported to be significantly associated with the PUFA contents. Whether the promoter SNPs (pSNPs) were associated with the PUFA contents has not been reported yet. In this study, after sequencing the promoters of these four genes, we identified six pSNPs associated with the contents of PUFAs in common carp, including one elovl5a pSNP, one elovl5b pSNP, and four fads2b pSNPs. The pSNPs were predicted in the locations of transcriptional factor binding sites. Together with previously identified cSNPs in fads2b and elovl5b, the pSNPs and cSNPs of these two genes had the joint effects on the PUFA contents with higher explained percentage of phenotypic variation of the PUFA contents than single gene. The expression levels of both fads2a and fads2b were significantly positively correlated with the contents of six PUFAs. The fads2b pSNPs corresponding to higher fads2b expression levels were associated with higher PUFA contents. The pSNPs and cSNPs will be useful for the future selection breeding of common carp with higher PUFA contents.

Visual analysis of image-guided radiation therapy based on bibliometrics: A review.

Radiation therapy plays an important role in tumor treatment. The development of image-guided radiation therapy (IGRT) technology provides a strong guarantee for precise radiation therapy of tumors. However, bibliometric studies on IGRT research have rarely been reported. This study uses literature collected from the Web of Science during 1987 to 2021 as a sample and uses the bibliometric method to reveal the current research status, hotspots, and development trends in IGRT. Based on 6407 papers published from the Web of Science during 1987 to 2021, we utilized Microsoft Excel 2007 and cite space software to perform statistical analysis and visualization of IGRT. A total of 6407 articles were included, this area of IGRT has gone through 4 stages: budding period, growth period, outbreak period, and stationary period. The research category is mainly distributed in Radiology Nuclear Medicine Medical Imaging, which intersects with the research categories of Materials, Physics, and Mathematics. Yin FF, Tanderup K, and Sonke JJ are highly productive scholars who are active in IGRT research, while Jaffray DA, van Herk M and Guckenberger M are authors with high impact in this field. The team of scholars has close cooperation within the team and weak cooperation among teams. The League of European Research Universities, University of Texas System, University of Toronto, and Princess Margaret Cancer are the main research institutions in this field. The United States has the most research literature, followed by China and Germany. Six thousand four hundred seven articles are distributed in 712 journals, and the top 3 journals are Med Phys, Int J Radiat Oncol, and Radiather Oncol. Precise registration, intelligence, magnetic resonance guidance, and deep learning are current research hotspots. These results demonstrate that the research in this field is relatively mature and fruitful in the past 35 years, providing a solid theoretical basis and practical experience for precision radiotherapy.

A unified framework of transformations based on the Jordan-Wigner transformation.

Quantum simulation of chemical Hamiltonians enables the efficient calculation of chemical properties. Mapping is one of the essential steps in simulating fermionic systems on quantum computers. In this work, a unified framework of transformations mapping fermionic systems to qubit systems is presented and many existing transformations-such as Jordan-Wigner, Bravyi-Kitaev, and parity transformations-are included in this framework. Based on this framework, the Multilayer Segmented Parity (MSP) transformation is proposed. The MSP transformation is a general mapping with an adjustable parameter vector, which can be viewed as a generalization of the above-mentioned mappings. Furthermore, the MSP transformation can adjust flexibly when dealing with different systems. Applying these mappings to the electronic structure Hamiltonians of various molecules, the MSP transformation is found to perform better on a number of Pauli operators and gates needed in the circuit of Hamiltonian simulation. The MSP transformation will reduce the qubit gate requirement for Hamiltonian simulation on noisy intermediate-scale quantum devices, and it will provide a much wider choice of mappings for researchers.

[Effects of Polystyrene Nanoplastics (PS-NPs) on the Physiology of Allium sativum L.]

The pollution of micro/nanoplastics in the natural environment is becoming increasingly serious, but the potential effects of nanoplastics on crops remain unclear. In the present study, the effects of polystyrene nanoplastics (PS-NPs) with a particle size of 80 nm on the chlorophyll content, antioxidant enzyme activity, and nutritional quality of Allium sativum L. were explored via hydroponic culture. The results showed that the chlorophyll contents in leaves of A. sativum treated with PS-NPs were significantly lower than those in the control, indicating that the synthesis of chlorophyll was inhibited. The superoxide dismutase (SOD), ascorbate peroxidase (APX) activities, and proline contents in leaves of A. sativum initially increased but then decreased with the increase in ρ(PS-NPs). The activity of guaiacol peroxidase (POD) increased with the increase in ρ(PS-NPs) for 10 days of treatment; however, it was inhibited for 20 days of treatment. The malondialdehyde (MDA) content increased with the rise in ρ(PS-NPs). When ρ(PS-NPs) increased to 100 mg·L-1, the MDA content in leaves of A. sativum increased by 43.24% and 89.70% for 10 and 20-day treatments, respectively, compared with those in the control. Meanwhile, the contents of soluble protein, soluble sugar, and vitamin C were higher than those in the control for 10-day treatments; however, the vitamin C content decreased by 26.53% after 20 days of treatment. These results indicated that PS-NPs had a significant oxidative stress on A. sativum, and a high concentration of PS-NPs stress would have deleterious effects on the nutritional quality of A. sativum.

Association Analysis between Genetic Variants of elovl5a and elovl5b and Poly-Unsaturated Fatty Acids in Common Carp (Cyprinus carpio).

The allo-tetraploid common carp, one widely cultured food fish, is able to produce poly-unsaturated fatty acids (PUFAs). The genetic markers on the PUFA contents for breeding was limited. The polymorphisms in elovl5a and elovl5b, the rate-limiting enzymes in the PUFA biosynthesis, have not been investigated yet. Herein, we identified one coding SNP (cSNP) in elovl5a associated with the content of one PUFA and two cSNPs in elovl5b with the contents of eight PUFAs. The heterozygous genotypes in these three loci were associated with higher contents than the homozygotes. Together with previously identified two associated cSNPs in fads2b, we found the joint effect of these four cSNPs in fads2b and elovl5b on the PUFA contents with the increased explained percentages of PUFA contents. The genotype combinations of more heterozygotes were associated with higher PUFA contents than the other combinations. Using ten genomic selection programs with all cSNPs in fads2b and elovl5b, we obtained the high and positive correlations between the phenotypes and the estimated breeding values of eight PUFAs. These results suggested that elovl5b might be the major gene corresponding to common carp PUFA contents compared with elovl5a. The cSNP combinations in fads2b and elovl5b and the optimal genomic selection program will be used in the future selection breeding to improve the PUFA contents of common carp.

Bulked Segregant Analysis and Association Analysis Identified the Polymorphisms Related to the Intermuscular Bones in Common Carp (Cyprinus carpio).

The allotetraploid common carp is one of the most important freshwater food fish. However, the IBs found in allotetraploid common carp increase the difficulty in fish meat processing and consumption. Although candidate genes associated with the total IB number have been identified, the SNPs associated with the numbers of the total IBs and different forms of IBs have not yet been identified, hindering the breeding of IB-reduced common carp. Herein, the numbers of different types of IBs in three common carp strains were measured. Using whole-genome resequencing and bulked segregant analysis in three pairs of IB-more and IB-less groups, we identified the consensus nonsynonymous SNPs in three strains of common carp. Screening the flanking regions of these SNPs led to the detection of other SNPs. Association study detected 21 SNPs significantly associated with the number of total IBs, epineural-IBs, and ten detailed types of IBs. We observed the joint effects of multiple SNPs on each associated IB number with an improved explained percentage of phenotypic variation. The resulting dataset provides a resource to understand the molecular mechanisms of IB development in different common carp strains. These SNPs are potential markers for future selection to generate IB-reduced common carp.

[Ozone Formation and Key VOCs of a Continuous Summertime O3 Pollution Event in Ji'nan].

In the summer of 2019, field measurements of ozone (O3) and its precursors[volatile organic compounds (VOCs) and nitrogen oxides (NOx)] were carried out at an urban site in Ji'nan. We found that the daily maximum 8-hour averages φ(O3) were (103.0±14.5)×10-9. The average φ(NOx) and φ(VOCs), which are ozone precursors, were (16.7±11.3)×10-9and (22.4±9.4)×10-9, respectively. The ·OH reactivity of VOCs was determined (9.6±3.8) s-1. Ji'nan suffered from serious O3 pollution. An observation-constrained chemical box model was deployed to evaluate in situ photochemical O3 production, which indicated that chemical reactions made positive contributions to O3 production rates between 07:00 and 19:00 LT, with the average hourly O3 production rate of 35.6×10-9 h-1. To evaluate the effectiveness of various ozone precursor control strategies in reducing ozone pollution, we combined the observation-based model (OBM) with the relative incremental reactivity (RIR) method. The key indicators that affect the local ozone production rate were identified. Ji'nan was under VOC-limited conditions and the key VOC precursors were alkenes. The O3 formation mechanism changed from the VOC-limited regime in the morning to the transitional regime in the afternoon. Correspondingly, the simulated local O3 production rate was increased from 18.3×10-9 h-1 to 29.6×10-9 h-1. To further explore the role of anthropogenic emissions in ozone pollution, we used the positive matrix factorization (PMF) model to identify the major sources contributing to VOCs. The major sources in Ji'nan were vehicular exhaust and gasoline evaporation, accounting for more than 50% of the observed VOCs. Therefore, constraints on vehicular emissions is the most effective strategy to control O3 pollution in Ji'nan.

Parallel subgenome structure and divergent expression evolution of allo-tetraploid common carp and goldfish.

How two subgenomes in allo-tetraploids adapt to coexistence and coordinate through structure and expression evolution requires extensive studies. In the present study, we report an improved genome assembly of allo-tetraploid common carp, an updated genome annotation of allo-tetraploid goldfish and the chromosome-scale assemblies of a progenitor-like diploid Puntius tetrazona and an outgroup diploid Paracanthobrama guichenoti. Parallel subgenome structure evolution in the allo-tetraploids was featured with equivalent chromosome components, higher protein identities, similar transposon divergence and contents, homoeologous exchanges, better synteny level, strong sequence compensation and symmetric purifying selection. Furthermore, we observed subgenome expression divergence processes in the allo-tetraploids, including inter-/intrasubgenome trans-splicing events, expression dominance, decreased expression levels, dosage compensation, stronger expression correlation, dynamic functionalization and balancing of differential expression. The potential disorders introduced by different progenitors in the allo-tetraploids were hypothesized to be alleviated by increasing structural homogeneity and performing versatile expression processes. Resequencing three common carp strains revealed two major ecotypes and uncovered candidate genes relevant to growth and survival rate.

Latanoprost eye drops induce conjunctival lymphatic vessel development.

AIM: To investigate the effect of latanoprost eye drops on the conjunctival lymphatics. METHODS: Twenty-four healthy New Zealand White rabbits weighing 1.5 to 2.0 kg were randomly divided into three groups: latanoprost group (n=8) administered with latanoprost eye drops once a day for 2mo, carteolol group (n=8) administered with carteolol eye drops once a day for 2mo, and control group (n=8) without any treatment. The conjunctival tissues in the three groups were extracted to investigate the expression levels of 5'-nucleotidase (5'-Nase) by Western blot, reverse transcription-polymerase chain reaction (RT-PCR), and immunofluorescence staining, respectively. RESULTS: The protein expression level of 5'-Nase was significantly higher in latanoprost group than carteolol group (F=231.175, P<0.001) and control group (P<0.001), while there was no significant difference between the carteolol group and the control group (P>0.05). The mRNA expression level of 5'-Nase in the latanoprost group was also significantly higher than carteolol group (F=71.169 P<0.005) and control group (P<0.005). The conjunctival lymphatics were positive immunofluorescence stained with the 5'-Nase antibodies in the latanoprost group and not stained in the control group. CONCLUSION: Latanoprost eye drops can induce conjunctival lymphangiogenesis which may be concerned in clinical implications.

Association between the Polymorphisms of fads2a and fads2b and Poly-Unsaturated Fatty Acids in Common Carp (Cyprinus carpio).

Fatty acid desaturase 2 (fads2) is one of the rate-limiting enzymes in PUFAs biosynthesis. Compared with the diploid fish encoding one fads2, the allo-tetraploid common carp, one most important food fish, encodes two fads2 genes (fads2a and fads2b). The associations between the contents of different PUFAs and the polymorphisms of fads2a and fads2b have not been studied. The contents of 12 PUFAs in common carp individuals were measured, and the polymorphisms in the coding sequences of fads2a and fads2b were screened. We identified five coding single nucleotide polymorphisms (cSNPs) in fads2a and eleven cSNPs in fads2b. Using the mixed linear model and analysis of variance, a synonymous fads2a cSNP was significantly associated with the content of C20:3n-6. One non-synonymous fads2b cSNP (fads2b.751) and one synonymous fads2b cSNP (fads2b.1197) were associated with the contents of seven PUFAs and the contents of six PUFAs, respectively. The heterozygous genotypes in both loci were associated with higher contents than the homozygous genotypes. The fads2b.751 genotype explained more phenotype variation than the fads2b.1197 genotype. These two SNPs were distributed in one haplotype block and associated with the contents of five common PUFAs. These results suggested that fads2b might be the major gene responding to common carp PUFA contents and that fads.751 might be the main effect SNP. These cSNPs would be potential markers for future selection to improve the PUFA contents in common carp.

Prognostic Model to Predict Overall Survival for Metastatic Non-Small Cell Lung Cancer Patients Treated With Chemotherapy Combined With Concurrent Radiation Therapy to the Primary Tumor: Analysis From Two Prospective Studies.

PURPOSE: The role of radiotherapy, in addition to chemotherapy, has not been thoroughly determined in metastatic non-small cell lung cancer (NSCLC). The purpose of the study was to investigate the prognostic factors and to establish a model for the prediction of overall survival (OS) in metastatic NSCLC patients who received chemotherapy combined with the radiation therapy to the primary tumor. METHODS: The study retrospectively reviewed 243 patients with metastatic NSCLC in two prospective studies. A prognostic model was established based on the results of the Cox regression analysis. RESULTS: Multivariate analysis showed that being male, Karnofsky Performance Status score < 80, the number of chemotherapy cycles <4, hemoglobin level ≤120 g/L, the count of neutrophils greater than 5.8 ×109/L, and the count of platelets greater than 220 ×109/L independently predicted worse OS. According to the number of risk factors, patients were further divided into one of three risk groups: those having ≤ 2 risk factors were scored as the low-risk group, those having 3 risk factors were scored as the moderate-risk group, and those having ≥ 4 risk factors were scored as the high-risk group. In the low-risk group, 1-year OS is 67.7%, 2-year OS is 32.1%, and 3-year OS is 19.3%; in the moderate-risk group, 1-year OS is 59.6%, 2-year OS is 18.0%, and 3-year OS is 7.9%; the corresponding OS rates for the high-risk group were 26.2%, 7.9%, and 0% (P<0.001) respectively. CONCLUSION: Metastatic NSCLC patients treated with chemotherapy in combination with thoracic radiation may be classified as low-risk, moderate-risk, or high-risk group using six independent prognostic factors. This prognostic model may help design the study and develop the plans of individualized treatment.

Mid-term results of total hip arthroplasty with modified trochanteric osteotomy in Crowe type IV developmental dysplasia of the hip.

BACKGROUND: This study aimed to explore mid-term clinical results of cementless total hip arthroplasty (THA) with modified trochanteric osteotomy in Crowe type IV developmental dysplasia of the hip (DDH). METHODS: Thirteen patients (13 hips) with Crowe type IV DDH who underwent THA with modified trochanteric osteotomy between May 2013 and October 2015 were retrospectively analyzed. The mean follow-up duration was 5.2 years (range, 4.9-6.1 years). RESULTS: The mean Harris Hip Score (HHS) significantly (p < 0.05) improved from 30.7 (range, 22-38) to 87.5 (range, 83-93). The mean leg length discrepancy (LLD) was 53.4 mm (range, 42.1-68.5 mm) preoperatively. The final LLD was 5.6 mm (range, 2.4-9.1 mm; p < 0.05). The mean leg length after surgery was 47.4 mm (range, 33.6-67.2 mm) and the femur shortening distance was 43.8 mm (range, 31.2-53.4 mm). The average duration of bone union for the greater trochanter (GT) was 2.5 months (range, 1.5-3.6 months). There was no infection, GT non-union, or loosening (septic or aseptic) of the stem or cup in any case. CONCLUSIONS: THA with modified trochanteric osteotomy with a cementless cup is an effective treatment for Crowe type IV DDH. It can rebuild complex biomechanics and biology of hip dysplasia without increasing complications.

[Pollution Characteristics and Risk Assessment of Antibiotics in Lianhua Reservoir].

Thirteen typical antibiotics in surface water of the Lianhua Reservoir were analyzed using HPLC/MS/MS to assess the pollution characteristics and risk levels. Ten antibiotics except for erythromycin, sulfadiazine, and sulfamethoxazole were detected in surface water and the total concentration of antibiotics varied between non-detectable (n.d.) and 925.26 ng ·L-1. Azithromycin had the highest concentration (n.d.-232.61 ng ·L-1) with the detection frequency of 75%, followed by enrofloxacin (n.d.-187.69 ng ·L-1), tetracycline (n.d.-155.05 ng ·L-1), and ciprofloxacin (n.d.-83.66 ng ·L-1) with the detection frequencies over 60%. The spatial distribution of antibiotics was as follows: total concentration of upstream (sampling point 1) > Aoxi River stream tributary (sampling point 2) > reservoir downstream (sampling point 3) > reservoir entrance (sampling point 4) > reservoir area (sampling point 5). The seasonal variations in the concentrations of antibiotics were evident; total concentrations in the dry season were significantly higher than those in the wet and normal seasons. The results of the environmental risk assessment indicated that ofloxacin, enrofloxacin, and ciprofloxacin pose significant risks to the environment. In the Lianhua Reservoir, ciprofloxacin showed high potential risk to the ecological environment, while the environmental risks of other antibiotics in the reservoir were below the medium level. The combined risk value of the antibiotics in the dry season was higher than that in the wet and normal seasons.

Simultaneous integrated boost of intensity-modulated radiation therapy to Stage II-III non-small cell lung cancer with metastatic lymph nodes.

Local tumor failure remains a major problem after radiation-based nonsurgical treatment for unresectable locally advanced nonsmall cell lung cancer (NSCLC）and inoperable stage II NSCLC. The aim of this study was to evaluate the feasibility of simultaneous integrated boost of intensity-modulated radiation therapy (SIB-IMRT) to stage II-III NSCLC with metastatic lymph nodes (ChiCTR 2000029304). Patients were diagnosed by pathology or PET-CT. PTV was divided into two parts as follows, the PTV of primary tumor (PTVp) and the PTV of metastatic lymph nodes (PTVn). The radiotherapy doses were simultaneously prescripted 78 Gy (BED = 101.48 Gy) for PTVp and 60-65 Gy (BED = 73.6-81.25 Gy) for PTVn, 26f/5.2 weeks. Response was scored according to WHO criteria. Radiotherapy toxicity was scored according to RTOG criteria. Hematology and gastrointestinal toxicity were scored according to CTCAE1.0 criteria. A total of 20 patients were enrolled. Seventeen patients were diagnosed by pathology and three patients were diagnosed by PET-CT. All patients were treated with SIB-IMRT. The objective response rate (ORR) was 90%, with CR 25%, PR 65%, NC 10%, and PD 0%. Although radiotherapy toxicity was common, there were no grade ≥3, with radiation pneumonitis (10 cases), esophagitis (17 cases), and dermatitis (12 cases). The local control rates at 1, 3, and 5 years were 85%, 75%, and 70%, respectively. The overall survival（OS）and local progression-free survival (LPFS) rates at 1, 3, and 5 years were 90%, 42.6%, and 35.5% and 84.4%, 35.5%, and 28.4%, respectively. SIB-IMRT can significantly improve ORR and survival for stage II-III NSCLC with metastatic lymph nodes, with high safety, and satisfactory efficacy. However, due to the limitation of small sample, these findings are needed to confirm by future trials with a larger sample size.

The results of screw augmentation of acetabular cement spacers for the treatment of periprosthetic hip joint infection.

INTRODUCTION: Prosthesis of antibiotic-loaded acrylic cement (PROSTALAC) is widely used in two-stage revision arthroplasty in periprosthetic joint infection (PJI) after total hip arthroplasty (THA). In our institution, we encountered several cases of acetabular cement spacer dislodgement. The aim of this study was to compare the results of two-stage revision arthroplasties with antibiotic-loaded cement spacers with or without screws on the acetabulum for PJI. PATIENTS AND METHODS: This retrospective study included 44 patients who underwent a two-stage revision THA for PJI from June 2007 to May 2017. We divided the patients into two groups: group 1 consisted of 21 patients (21 hips) who underwent two-stage revision arthroplasty with screw augmentation, while group 2 consisted of 23 patients (23 hips) who underwent the same surgery without screw augmentation at the acetabular cement spacer. We compared the migration and dislodgement of the acetabular cement spacer between the two groups. RESULTS: Before the second-stage surgery, there was less vertical migration of the cement spacer in group 1 compared to group 2 (1.2 mm vs 3.1 mm, p < 0.001). There was also less medial migration of the cement spacer in group 1 (0.6 mm vs 1.6 mm, p = 0.001). After the first stage, the mean Harris Hip score was significantly higher in group 1 than in group 2 (75 vs 65, p = 0.033). Cement spacer rotation or total movement out of the acetabular area occurred in six patients, all in group 2. After first stage reinfection occurred in two patients, one in each group. CONCLUSIONS: Screw augmentation to the acetabulum in the first-stage surgery provides better stability of acetabular antibiotic cement spacers without increasing reinfection rate.

[Distribution of Four Artificial Sweeteners in Water Treatment and Water Supply System in City H of Zhejiang Province].

Taking the sewage and drinking water treatment system of two cities in Zhejiang Province as the main research target, a systematic investigation on the common artificial sweeteners was carried out by solid phase extraction-high performance liquid chromatography (SPE-HPLC). The results showed that SPE-HPLC can accurately determine micro acesulfame (ACE), saccharin (SAC), aspartame (ASP), and neotame (NEO) in water. The detection limits were 57, 120, 170, and 47 µg·L-1, and the quantification limits were 190, 400, 567, and 157 µg·L-1, respectively. After optimization of the solid phase extraction procedure when using PWAX columns, the recoveries of ACE and SAC were enhanced to 86.5% and 97.7%; however, it slightly decreased to 66.5% for NEO. The occurrence rates of ACE, SAC, and NEO in domestic sewage were 100.0%, and it was only 33.3% for ASP. The highest concentrations of four aforementioned artificial sweeteners in domestic sewage were 0.83, 4.52, 1.22, and 7.57 µg·L-1, respectively. The highest concentrations of acesulfame, saccharin, aspartame, and neotame in source water were 22.94, 39.17, 0.73, and 8.92 µg·L-1, respectively, and detection rates were 72.7%, 90.9%, 18.2%, and 90.9%, respectively. Most artificial sweeteners were removed by the prozone process; the removal efficiencies of ACE, SAC, and NEO ranged from 67.7% to 100.0%, and the removal efficiencies of ACE, SAC, and NEO by the advanced treatment process ranged from 73.7% to 100.0%, which effectively reduced the risk of drinking water quality. The four artificial sweeteners were not detected in the water supply network.

[Distribution Characteristics of Disinfection By-Products and the Effects of Booster Chlorination in Long-Distance Water Supply Systems].

It is difficult for waterworks that add chlorine into finished water once to maintain sufficient residual chlorine at unfavorable points of the pipe network that supply water for large areas of coverage. Therefore, booster chlorination was employed for a long-distance water distribution system. The study was performed in H City with a water supply system serving about 400 km2 of downtown and rural areas. The purpose of this work is to obtain the distribution characteristics of disinfection by-products (DBPs) in the booster chlorination disinfection pipe network through uniformly distributed sampling analysis. The results showed that detected DBPs include trichloromethane (TCM), bromodichloromethane (BDCM), dibromochloromethane (DBCM) and tribromomethane (TBM), dichloroacetic acid (DCAA), trichloroacetic acid (TCAA), dichloroacetonitrile (DCAN), bromochloroacetonitrile (BCAN), and trichloronitromethane (TCNM). The concentrations of the regulated DBPs were found to be lower than the standard limits specified in the Sanitary Standard for Drinking Water (GB5749-2006). Before booster chlorination, the average concentrations of the DBPs mentioned (expressed as mean±deviation) were (8.08±3.34), (9.77±2.91), (7.38±4.82), (2.65±2.02), (2.95±3.26), (6.02±6.06), (3.13±2.48), (1.61±2.05), and (0.15±0.10) µg·L-1, while afterwards, they were increased to (10.30±4.55), (11.73±3.60), (8.23±5.22), (2.95±2.45), (3.29±3.60), (8.15±7.58), (3.31±2.61), (1.33±2.04), and (0.12±0.06) µg·L-1, respectively. Trihalomethanes (THMs) and haloacetic acids (HAAs) increased by 6.32%-26.60% and 5.32%-42.71%, respectively, after booster chlorination. In addition, raw water quality and seasonal changes had a certain impact on the occurrence of DBPs. The levels of DBPs in summer were generally higher than those in spring or autumn. According to the analysis of DBP formation potential of source water, finished water, and tap water, it was found that the risk of DBPs exceeding the standard limit may exist in the water supply system of H City; therefore, further optimization of the treatment process should be considered to ensure water quality.