Enrichment performance and salt tolerance of polyhydroxyalkanoates (PHAs) producing mixed cultures under different saline environments.

The key to the resource recycling of saline wastes in form of polyhydroxyalkanoates (PHA) is to enrich mixed cultures with salt tolerance and PHA synthesis ability. However, the comparison of saline sludge from different sources and the salt tolerance mechanisms of salt-tolerant PHA producers need to be clarified. In this study, three kinds of activated sludge from different salinity environments were selected as the inoculum to enrich salt-tolerant PHA producers under aerobic dynamic feeding (ADF) mode with butyric acid dominated mixed volatile fatty acid as the substrate. The maximum PHA content (PHAm) reached 0.62 ± 0.01, 0.62 ± 0.02, and 0.55 ± 0.03 g PHA/g VSS at salinity of 0.5%, 0.8%, and 1.8%, respectively. Microbial community analysis indicated that Thauera, Paracoccus, and Prosthecobacter were dominant salt-tolerant PHA producers at low salinity, Thauera, NS9_marine, and SM1A02 were dominant salt-tolerant PHA producers at high salinity. High salinity and ADF mode had synergistic effects on selection and enrichment of salt-tolerant PHA producers. Combined correlation network with redundancy analysis indicated that trehalose synthesis genes and betaine related genes had positive correlation with PHAm, while extracellular polymeric substances (EPS) content had negative correlation with PHAm. The compatible solutes accumulation and EPS secretion were the main salt tolerance mechanisms of the PHA producers. Therefore, adding compatible solutes is an effective strategy to improve PHA synthesis in saline environment.

Ecological succession and community assembly of mixed microbial culture polyhydroxyalkanoate production systems: Drivers of polyhydroxyalkanoate synthesis and Bdellovibrio predation.

The production of polyhydroxyalkanoate (PHA) by mixed microbial culture (MMC) can reduce the pollution of plastics. Ecophysiological study of the microbial community assembly and succession is helpful for comprehensive understanding the MMC PHA production process. The operation mode of sequential aerobic dynamic discharge - aerobic dynamic feeding (ADD-ADF) was applied and the operation can be divided into acclimation phase and maturation phase. Deterministic process caused by selective pressure dominated the community assembly throughout the operation. In the acclimation phase, the physical selective pressure recovered the settling capacity of the system, and settling ability of the MMC was closely related to function of PHA synthesis. However, in the maturation phase, stochastic process caused sludge bulking, making the settling ability and PHA synthesis function of the MMC independent on each other. Stochastic process led to the succession of the dominant PHA-producing bacteria, for example, the predation of Paracoccus and Thauera by Bdellovibrio.

Removal of methylene blue by acrylic polymer adsorbents loaded with magnetic iron manganese oxides: Synthesis, characterization, and adsorption mechanisms.

Dyes pose significant risks for aquatic environments and biological health in general owing to their non-biodegradable nature, carcinogenicity, and toxicity. The effective treatment of dye wastewater has become an important research topic. In this study, acrylic polymers (AP) loaded with magnetic iron manganese oxides (MIMO) (AP/MIMO) were prepared and used for the first time for the adsorption of methylene blue (MB). Carbon in AP/MIMO exists predominantly in the C-H and C-C forms, with its content reaching 50.7%. Oxygen and nitrogen in AP/MIMO exist mainly in the -CO- and -N-C forms, with contents of up to 41.5% and 73.3%, respectively. MB removal by AP/MIMO was consistent with the pseudo-second-order kinetic model (R2 = 0.99), equilibrium was achieved within 20 min, and the highest MB capacity of 2611.23 mg g-1 was predicted by the Langmuir isotherm model (R2 = 0.91-0.94). AP/MIMO exhibited excellent MB adsorption performance in the pH range of 4-10, with a removal efficiency higher than 99.0% (MB = 100 mL 1000 mg L-1; AP/MIMO = 50 mg). Thermodynamic indicators, such as positive entropy (ΔS0; 98.30 J⋅mol-1⋅K-1), negative Gibbs free energy (ΔG0; -29.40, -28.50, and -27.50 KJ⋅mol-1), and positive enthalpy (ΔH0; 2.30 KJ⋅mol-1), demonstrated that MB removal by AP/MIMO was autonomous, favorable, and endothermic. In addition, the integration of experimental results and theoretical calculations verified that electrostatic interactions were the primary mechanism for MB adsorption at carboxyl sites on AP/MIMO. The total interaction energy between AP and MB was -310.43 kJ⋅mol-1, and the electrostatic effect had a decisive contribution to the MB adsorption, with a value of up to -341.06 kJ⋅mol-1. AP and MB were most likely bound by -COO and S atoms. Overall, AP/MIMO exhibits high adsorption capacity and shows potential as a high-performance magnetic polymer for MB removal.

Towards Carbon Neutrality: Carbon Emission Performance of Science and Technology Finance Policy.

Combining technology with finance is the focus of supporting economic structure adjustment, and environmental benefits are also the proper meaning of the policy. Using the panel data of 274 cities in China from 2006 to 2017, this paper examines the impact of the Science and Technology Finance Policy (STFP) on carbon emission intensity in pilot cities and the transmission mechanisms through the difference-in-differences method and further explores the impact of STFP on the carbon emission intensity in neighboring cities. The results show that (1) STFP has significantly reduced carbon emission intensity in pilot cities and has dynamic effects, which gradually increase over time. There is significant heterogeneity in the carbon emission reduction effect of STFP, which produces stronger policy effects in first and second-tier cities and cities with higher information levels. (2) STFP achieves carbon emission reduction effects through three main pathways: the total factor productivity improvement effect, innovative elements agglomeration effect, and industrial structure optimization effect. (3) The STFP and national e-commerce demonstration policy have an interactive effect, and the two jointly contribute to the reduction in carbon emission intensity. From the perspective of a spatial effect, STFP has a radiation effect; that is, STFP not only reduces local carbon emission intensity but also curbs the carbon emission intensity in neighboring areas.

Does the new energy demonstration cities construction reduce CO2 emission? Evidence from a quasi-natural experiment in China.

Based on the panel data of 279 cities in China from 2003 to 2017, this paper regards the new energy demonstration cities (NEDC) construction as a quasi-natural experiment, using the double-fixed effect model and the difference-in-differences (DID) method to test its local carbon emission reduction effect and transmission mechanisms and further explores the impact of NEDC on neighboring carbon emissions. Results show that (1) NEDC reduces carbon emission intensity and per capita carbon emission significantly and shows dynamic sustainability. The policy effect has shown a trend of increasing year by year. Moreover, there is significant heterogeneity in the carbon emission reduction effect of NEDC, which produces more significant policy effect in large-scale and non-resource-based cities. (2) NEDC construction reduces carbon emission through green technology innovation effect, innovative elements agglomeration effect, and total factor productivity improvement effect. In terms of the contribution of reducing carbon emission intensity and per capita carbon emission, total factor productivity accounts for 36.7% and 21.5%, respectively, green technology innovation accounts for 18.6% and 23.9%, respectively, the contribution of R&D personnel agglomeration is 7.5% and 8.3%, respectively, and the contribution of R&D capital agglomeration is 5.9% and 9.5%, respectively. (3) From the perspective of spatial effect, the impact of NEDC on carbon emissions presents a "siphon" effect; that is, although NEDC reduces local carbon emissions, it has produced the phenomenon of transfer to neighboring areas, accelerating the increase in the carbon emission intensity of neighboring areas.

Rapid recovery of mixed culture polyhydroxyalkanoate production system from EPS bulking using azithromycin.

The long-term stable operation of the mixed culture polyhydroxyalkanoate (PHA) enrichment stage is the guarantee for the continuous synthesis of PHA, however extracellular polymeric substances (EPS) sludge bulking occurred from time to time may cause the operation fail. In order to solve this problem, as a quencher of signal molecules and antibiotic, azithromycin (AZM) was used in the two systems with different modes to recover the sedimentation capacity of the sludge. The results showed that AZM addition resulted in the reduction of polysaccharide /protein (PS/PN) ratio in EPS and significant improvement of the sedimentation capacity of the sludge. Quorum quenching of AZM or aiiA gene maintained the sedimentation ability of the sludge in a relay mode. By adding AZM, the growth of Thauera and Flavobacterium, which caused sludge bulking, was inhibited. Paracoccus, a strong PHA producer, has been enriched to ensure that the maximum PHA synthesis of the system.

Simultaneous recovery of vivianite and produce short-chain fatty acids from waste activated sludge using potassium ferrate as pre-oxidation treatment.

Recovery resources from waste active sludge (WAS) is an effective way to alleviate the predicament of WAS disposal, and it is also conducive to the carbon neutralization of wastewater treatment systems. This study discussed the strategy of WAS anaerobic fermentation after pre-oxidation with potassium ferrate (K2FeO4, PF), which can simultaneously recover vivianite and enhance SCFAs production. The results showed that PF pre-oxidation considerably shortened the fermentation time of SCFAs to 2 days, and the main Fe-P mineral was vivianite. The optimal PF dosage of 0.06 g Fe (VI)/g TSS for pre-oxidation WAS resulted in the maximum SCFAs production and vivianite recovery rate of 3698.2 ± 118.98 mg COD/g VSS and 32.39%, respectively. The mechanism analysis showed that the oxidizing properties of PF significantly accelerated the disintegration of tight EPS, release of protein and sludge acidification efficiency. Moreover, the PF strengthened the transfer of P to the solid phase, forming the Fe-P mineral and unsaturated coordination state of phosphate group. Then the key microorganism Geobacter reduced the Fe3+ in Fe-P state to Fe2+ and combined unsaturated phosphate to form vivianite. This study provides an alternative method for resource recovery and environmentally friendly disposal of WAS and contributes to the carbon neutrality of urban water systems.

Does regional planning policy of Yangtze River Delta improve green technology innovation? Evidence from a quasi-natural experiment in China.

Green technology innovation is an important way to solve the dilemma of economic growth and environmental protection, while the relevant policies issued by the government have an important impact on the promotion of regional green technology innovation. This paper regards the implementation of the Regional Planning of Yangtze River Delta (RPYRD) as a quasi-natural experiment, using the panel data of 274 cities in China from 2003 to 2016 to explore the green technology innovation effect of regional planning and its transmission mechanisms through the double-fixed effect model and the difference-in-difference (DID) method. The results show that (1) the implementation of the RPYRD promotes regional green technology innovation significantly and the green technology innovation effect of the policy is increasing year by year. (2) There is significant regional heterogeneity in the incentive effect of green technology innovation in regional planning. The policy effect is more obvious in cities with a larger scale, a higher level of human capital and less resource dependence. (3) The regional planning promotes green technological innovation by optimizing industrial structure, reducing FDI and increasing R&D investment.

[Role of P2X7 receptor in osteogenic differentiation of human periodontal ligament stem cells].

PURPOSE: To investigate the role of P2X7 receptor (P2X7r) in osteogenic differentiation of human periodontal ligament stem cells (hPDLSCs). METHODS: hPDLSCs were isolated from the premolars collected in the First Affiliated Hospital of Guiyang University of Traditional Chinese Medicine, and divided into four groups. Group A was cultured in conventional medium, group B was cultured in osteogenic induction medium, group C was cultured in osteogenic induction medium + 100 nmol/L adenosine triphosphate (ATP) solution, and group D was cultured in osteogenic induction medium + 100 nmol/L P2X7 receptor specific antagonist KN-62. After 7 days, alizarin red staining was used to observe the osteogenic effect of hPDLSCs in each group. The mRNA expression of osteocalcin (OCN), RUNX2 and P2X7r in hPDLSCs was detected by real-time PCR reaction (RT-PCR). The data were processed by SPSS 22.0 software package. RESULTS: Alisarin red staining showed that the morphology of hPDLSCs cells in group B and group C was significantly changed. The pale calcified nodules in group C were significantly more than those in group B, while very few calcified nodules were found in group A and group D. The mRNA expression of OCN, RUNX2 and P2X7r in hPDLSCs were the highest in group C, followed by group B(P<0.05), and no difference was found between group A and group D(P>0.05). CONCLUSIONS: P2X7 receptor can promote osteogenic differentiation of human periodontal ligament stem cells after being activated by ATP, which may provide a new direction for clinical treatment of periodontitis.

Substrate strategy optimization for polyhydroxyalkanoates producing culture enrichment from crude glycerol.

Crude glycerol is by-product produced from biodiesel industry and can be converted directly by mixed microbial culture (MMC) into polyhydroxyalkanoates (PHAs). This study investigated the effects of the reverse (SBR_A) and positive (SBR_B) glycerol gradient substrate strategy on PHA-accumulating culture enrichment and the maximum PHA accumulating stability under substrates with different glycerol and volatile fatty acid (VFA) proportion. The results showed that crude glycerol was mainly used for PHA production rather than biomass growth in SBR_A. The maximum qPHA was 0.65 g COD/g X-1·h-1 under sole crude glycerol condition in SBR_A, which was 2.41 times higher than that of SBR_B. Moreover, the PHA accumulating ability of the biomass from SBR_A was more stable than SBR_B. Saccharibacteria_genera_incertae_sedis was for the first time found to be the dominant genus using crude glycerol for PHA production. This research provides an insight into enrichment strategy to effectively enrich PHA-accumulating culture from crude glycerol.

The nitrogen removal and sludge reduction performance of a multi-stage anoxic/oxic (A/O) biofilm reactor.

To overcome the problems of high excess sludge yield and poor nitrogen removal efficiency in traditional biological treatment processes, a multi-stage A/O biofilm reactor was developed by combining the multi-stage A/O process with novel floating spherical carriers, resulting in repeated coupling of anoxic and aerobic environments. Results showed that the system achieved COD, NH 4 + - N , and TN removal efficiencies of 93.8%, 84.5%, and 75.7%, respectively, with average effluent concentrations lower than: 29.8 COD mg/L, 4.3 NH 4 + - N  mg/L, and 13.2 TN mg/L. The observed sludge yield was 0.139 g MLSS/g COD, which was lower than that of the conventional activated sludge process. Microbial analysis showed that the community structure and cell morphology of microorganisms changed greatly with alternating aerobic-anoxic condition; high-throughput sequencing results proved that functional microorganisms can be enriched on the surface of the carries and therefore improved the nitrogen removal efficiency and meanwhile minimize the sludge yield within the system. PRACTITIONER POINTS: The research innovatively developed a novel floating spherical carrier and coupled it with multi-stage A/O process. The complex redox environments inside the floating spherical carriers improves the nitrogen removal efficiency and the sludge reduction effect. Nitrospirae, Hydrogenophaga promoted the nitrogen removal, Firmicutes, Bacteroidetes and Dechloromonas promoted the in-situ sludge reduction of the system.

Chemotherapy for breast cancer progresses to liver metastases after surgery and systemic treatment.

BACKGROUND: This study aims to evaluate the effectiveness of hepatic arterial infusion chemotherapy/portal vein infusion chemotherapy (HAIC/PVIC), transcatheter hepatic arterial chemoembolization (TACE) and transcatheter arterial embolization (TAE) for unresectable breast cancer liver metastases (UBCLM). METHODS: The present study included 57 patients. These patients were randomly divided into three groups (n=19, each): HAIC/PVIC group, TACE group and TAE group. Patients in the HAIC/PVIC group were treated with the same systemic chemotherapy regimen previously received by infusion through an intra-arterial and portal vein catheter. Patients in the TACE group received cyclophosphamide, epirubicin and 5-fluorouracil, and embolization. Patients in the TAE group were only treated with embolization. RESULTS: The median number of treatments was 6 (range, 3-13) in the HAIC/PVIC group, 5 (range, 4-9) in the TACE group, and 6 (range, 4-8) in the TAE group. The 1-, 2- and 3-year survival rates for these groups were 18/19 (94.7%), 14/19 (73.7%) and 11/19 (57.9%), 14/19 (73.7%), 9/19 (47.4%) and 8/19 (42.1%), and 8/19 (42.1%), 4/19 (21.1%) and 0/19 (0%), respectively. The median overall survival from the original breast cancer diagnosis was 88 (range, 11-133), 75 (range, 9-115), and 49 (range, 10-64) months in the HAIC/PVIC, TACE and TAE groups, respectively. Grade I-II and grade III-IV bone marrow suppression was observed in 12/19 (63.2%) and 3/19 (15.8%) patients in the HAIC/PVIC group, respectively, in 17/19 (89.5%) and 5/19 (26.3%) patients in the TACE group, respectively, and in 0/19 (0%) and 0/19 (0%) patients in the TAE group, respectively. CONCLUSIONS: HAIC/PVIC with the same regional chemotherapy regimen of the original systemic treatment is feasible, and can benefit patients with UBCLM, who have progressed on prior systemic therapies.

Long noncoding RNA HOXA11-AS promotes gastric cancer cell proliferation and invasion via SRSF1 and functions as a biomarker in gastric cancer.

BACKGROUND: Gastric cancer (GC) is the fourth most frequent malignancy all over the world. The diagnosis of GC is challenging and the prognosis of GC is very unfavorable. Accumulating evidence reveals that serum long noncoding RNAs (lncRNAs) can function as biomarkers in various types of cancers, including GC. AIM: To explore the level and molecular mechanism of the lncRNA HOXA11-AS in GC and the diagnostic and prognostic significance of serum HOXA11-AS in GC. METHODS: HOXA11-AS levels in GC tissue, cell lines, and serum samples were measured. The correlation between HOXA11-AS expression and clinicopathological characteristics was analyzed. The role of HOXA11-AS in the diagnosis and prognosis of GC was evaluated. Cell function assays were performed for exploration of the roles of HOXA11-AS in GC cells. Moreover, Western blot was performed to explore the target regulated by HOXA11-AS in GC cells. RESULTS: Up-regulation of HOXA11-AS was found in GC tissues, cell lines, and serum samples. In GC patients, decreased serum HOXA11-AS levels were negatively related with tumor size, TNM stage, and lymph node metastasis. The area under the receiver operating characteristic curve of serum HOXA11-AS in the diagnosis of GC was 0.924 (95%CI: 0.881-0.967; sensitivity, 0.787; specificity 0.978). Results of the Kaplan-Meier survival curves suggested the GC patients with a lower HOXA11-AS level having a better overall survival rate. HOXA11-AS promoted GC cell proliferation and invasion. SRSF1 may be the target regulated by HOXA11-AS in GC cells. CONCLUSION: HOXA11-AS promotes GC cell proliferation and invasion via SRSF1 and may function as a promising marker in GC.

Development and validation of a prediction rule for estimating gastric cancer risk in the Chinese high-risk population: a nationwide multicentre study.

OBJECTIVE: To develop a gastric cancer (GC) risk prediction rule as an initial prescreening tool to identify individuals with a high risk prior to gastroscopy. DESIGN: This was a nationwide multicentre cross-sectional study. Individuals aged 40-80 years who went to hospitals for a GC screening gastroscopy were recruited. Serum pepsinogen (PG) I, PG II, gastrin-17 (G-17) and anti-Helicobacter pylori IgG antibody concentrations were tested prior to endoscopy. Eligible participants (n=14 929) were randomly assigned into the derivation and validation cohorts, with a ratio of 2:1. Risk factors for GC were identified by univariate and multivariate analyses and an optimal prediction rule was then settled. RESULTS: The novel GC risk prediction rule comprised seven variables (age, sex, PG I/II ratio, G-17 level, H. pylori infection, pickled food and fried food), with scores ranging from 0 to 25. The observed prevalence rates of GC in the derivation cohort at low-risk (≤11), medium-risk (12-16) or high-risk (17-25) group were 1.2%, 4.4% and 12.3%, respectively (p<0.001).When gastroscopy was used for individuals with medium risk and high risk, 70.8% of total GC cases and 70.3% of early GC cases were detected. While endoscopy requirements could be reduced by 66.7% according to the low-risk proportion. The prediction rule owns a good discrimination, with an area under curve of 0.76, or calibration (p<0.001). CONCLUSIONS: The developed and validated prediction rule showed good performance on identifying individuals at a higher risk in a Chinese high-risk population. Future studies are needed to validate its efficacy in a larger population.

Effectiveness of acupuncture for vascular cognitive impairment no dementia: a randomized controlled trial.

OBJECTIVE:: To evaluate the effectiveness of acupuncture in patients with vascular cognitive impairment no dementia (VCIND) in comparison with citicoline, an agent for cognitive disturbances associated with chronic cerebral disorders. DESIGN:: A randomized controlled multicenter trial. SETTING:: In three hospitals in Beijing, China. SUBJECTS:: A total of 216 patients with VCIND were recruited. INTERVENTIONS:: Patients with VCIND (mean age of 65.4 years) were randomized to receive acupuncture (two sessions per week) or oral citicoline (100 mg three times daily) over three months. MAIN MEASURES:: The primary outcome was the change from baseline to three months in cognitive symptom, measured by Alzheimer's disease Assessment Scale, cognitive subscale (ADAS-cog). Secondary outcomes included changes from baseline to six months in ADAS-cog, executive function measured by the Clock Drawing Test (CDT), and functional disability measured by the Ability of Daily Living (ADL) scale at three and six months. RESULTS:: At three months, the acupuncture group had a greater decrease in mean ADAS-cog score (-2.33 ± 0.31) than the citicoline group (-1.38 ± 0.34) with a mean difference of -0.95 (95% CI, -1.84 to -0.07, P = 0.035). The mean change from baseline to six months in ADAS-cog also significantly favored acupuncture treatments (acupuncture change -2.61 vs citicoline -1.25, difference: -1.36 points; 95% CI, -2.20 to -0.51; P = 0.002). There was no difference between the two groups on CDT and ADL scores at either time point. CONCLUSION:: Compared with citicoline, acupuncture has comparable and even superior efficacy with improved cognitive and daily living performance as a complementary and alternative medicine treatment for VCIND.

Motion style acupuncture therapy for shoulder pain: a randomized controlled trial.

BACKGROUND: Strategies for preventing the persistence of pain and disability beyond the acute phase in shoulder pain patients are critically needed. Conventional acupuncture therapy (CAT) or motion style acupuncture therapy (MSAT) alone results in relative improvements in painful conditions in shoulder pain patients; combined interventions may have more global effects. The aim of this study is to evaluate the efficacy and safety of MSAT vs CAT for shoulder pain. METHODS: A randomized controlled trial using a factorial design was conducted from January 2014 to December 2015. Patients with a primary complaint of one-sided shoulder pain participated at three study sites. Eligible individuals were randomly assigned to receive MSAT plus minimal CAT (mCAT), CAT plus minimal MSAT (mMSAT), MSAT plus CAT, or mMSAT plus mCAT for 6 weeks in a 1:1:1:1 ratio. The primary outcome was change in shoulder pain intensity (measured using visual analog scale). The secondary outcomes included change in function of the shoulder joint (Constant-Murley score) and the health-related quality of life (Short Form-36 Health Survey). Moreover, perceived credibility of acupuncture was measured using the Treatment Credibility Scale. The outcomes were assessed at baseline and at 6, 10, and 18 weeks after randomization. Analysis of covariance with the baseline score adjustment had been used to determine the primary end point. The between-group differences of MSAT vs mMSAT and CAT vs mCAT were estimated, respectively, after tests of interaction between the two-dimensional interventions. All main analyses followed the intention-to-treat principle. RESULTS: A total of 164 patients completed the study. MSAT was superior to mMSAT in alleviating pain intensity at 10 weeks (P=0.024), and it was maintained for 18 weeks (P=0.013). Statistically significant differences were found when comparing MSAT with mMSAT for improvement in shoulder function (6 weeks, P=0.01; 10 weeks, P=0.006; and 18 weeks, P=0.01), physical health (10 weeks, P=0.023 and 18 weeks, P=0.015), and mental health (18 weeks, P=0.05). No significant differences were found in CAT when compared with mCAT. CONCLUSION: After 18 weeks of treatment, pain and joint functions are improved more with MSAT than with minimal motion style acupuncture or conventional acupuncture in patients with shoulder pain.

Research on CFD numerical simulation and flow field characteristics of countercurrent-cocurrent dissolved air flotation.

Countercurrent-cocurrent dissolved air flotation (CCDAF), the popular water purification device, which consists of collision and adhesion contact zones, showed favorable flotation conditions for micro-bubble adhesion and stability. In this study, computational fluid dynamics (CFD) numerical simulation was employed to confirm that the unique CCDAF configuration create reasonable and that the flow field characteristics were good no matter for single phase or gas-liquid two-phase conditions. In addition, the turbulence of the flow field was enhanced with the increasing influent load; the swirling was remarkably reduced with the increase of gas holdup. Meanwhile, a thick micro-bubble filter layer was formed in the separation zone, which favored bubble-flocs agglomerating and rising. The force analysis also showed that the cross section within the tank contribute to the uniformity of the bottom water collection as well as enlargement of the bottom outflow area, therefore improving the overall flotation performance. The simulation results revealed for the CCDAF process can provide technical guidance for engineering design and application.

Randomized controlled trial: Standard versus supplemental bowel preparation in patients with Bristol stool form 1 and 2.

BACKGROUND: Bristol stool form 1 and 2 is an important predictor of inadequate bowel preparation. AIM: To evaluate the efficacy of supplemental preparation in bowel cleansing quality among patients with Bristol stool form 1 and 2, as well as the feasibility of tailored bowel preparation guided by Bristol stool form scale. METHODS: Patients with Bristol stool form 1 and 2 from 3 Chinese tertiary hospitals randomly received either 2 L PEG-ELP (group A) or 10 mg bisacodyl plus 2 L PEG-ELP (group B); patients with Bristol stool form 3 to 7 received 2 L PEG-ELP (group C) for bowel preparation. The primary endpoint is the rate of adequate bowel reparation for the whole colon. The adequate bowel preparation rate for separate colon segments, the polyp detection rate (PDR), tolerability, acceptability, sleeping quality and compliance were evaluated as secondary endpoints. RESULTS: 700 patients were randomized. In per-protocol analysis, patients in group B attained significantly higher successful preparation rate than group A (88.7% vs. 61.2%, p<0.001) and similar with group C (88.7% vs. 85.0%, p = 0.316). The PDR in group B was significantly higher than group A (43.2% vs. 25.7%, p<0.001). Acceptability was much higher in group B and C. CONCLUSIONS: 10 mg bisacodyl plus 2 L PEG-ELP can significantly improve both bowel preparation quality and PDR in patients with Bristol stool form 1 and 2. Bristol stool form scale may be an easy and efficient guide for tailored bowel preparation before colonoscopy.

Effect of immune suppression on metastasis in a patient with hepatocellular carcinoma metastasized to the colon and stomach: A case report.

Hepatocellular carcinoma (HCC) is a highly malignant cancer, which can invade the portal vein and cause liver/long bone metastasis, although digestive tract metastatic tumor from the liver is very rare. This case report describes an unusual case of HCC (clear cell type), determined by pathology of the original liver tumor resected on March 16th, 2004. The patient returned to our hospital in February and July 2009 complaining of 'black stool' in the first instance, and 'anemia' on the second occasion. Colonoscopy and gastroscopy indicated colon cancer and stomach cancer, respectively. The right half colon and distal stomach were resected, and pathological inspection revealed liver cancer metastasis. The patient succumbed to respiratory failure due to liver cancer lung metastasis on the May 23rd, 2013. Tests for CD4+ and CD8+ T cells and the CD4+/CD8+ ratio, in addition to the expression of Fas, Fas ligand (FasL), indicated an evident difference in patient immunity during the tumor metastasis period. The disease progression in this patient suggested that immune surveillance may have been involved in the metastases. Furthermore, this case shows that clinicians should be alert to the possibility of metastases in uncommon sites that may be misdiagnosed as primary tumors. Surgical resection remains a valuable treatment for isolated digestive tract metastasis from liver cancer.

[Design and Implementation of a Mobile Operating Room Information Management System Based on Electronic Medical Record].

A mobile operating room information management system with electronic medical record (EMR) is designed to improve work efficiency and to enhance the patient information sharing. In the operating room, this system acquires the information from various medical devices through the Client/Server (C/S) pattern, and automatically generates XML-based EMR. Outside the operating room, this system provides information access service by using the Browser/Server (B/S) pattern. Software test shows that this system can correctly collect medical information from equipment and clearly display the real-time waveform. By achieving surgery records with higher quality and sharing the information among mobile medical units, this system can effectively reduce doctors' workload and promote the information construction of the field hospital.