Search

Cachexia is prevalent in cancer patients. The conventional diagnostic criteria for cachexia are often based on Western evidence, lacking consensus for Asian populations. This study aims to compare Asian Working Group for Cachexia (AWGC) criteria with Fearon's criteria, assessing their differences in population characteristics and prognostic impact. The clinical data of patients who underwent radical gastrectomy between 2013 and 2019 were prospectively collected. Cachexia diagnosis involves the utilization of either AWGC criteria and the previous international consensus proposed by Fearon et al. A scoring model is established based on the optional criteria according to the AWGC criteria. Univariate and multivariate logistic and Cox regression analysis were conducted to determine the independent effect factors for postoperative complications and overall survival. In a total of 1330 patients, 461 met AWGC cachexia criteria and 311 met Fearon's criteria. Excluding 262 overlapping cases, those diagnosed solely with AWGC-cachexia had higher age and lower BMI, albumin, hemoglobin, and handgrip strength compared to those by Fearon's criteria alone. AWGC-cachexia independently increased the risk of postoperative complications, whereas Fearon's criteria did not. Patients with AWGC-cachexia also exhibited shorter overall survival than Fearon's criteria. The AWGC-based cachexia grading system effectively stratifies the risks of postoperative complications and mortality. The AWGC criteria is more effective in diagnosing cancer cachexia in the Asian population and provide better prognostic indicators. [ABSTRACT FROM AUTHOR]

Malnutrition is common in the patients with gastric cancer. Radical gastrectomy remained the primary strategy of curable treatment for gastric cancer. This study is performed to explore the effect of laparoscopic radical gastrectomy on clinical outcomes in gastric cancer patients with malnutrition. Gastric cancer patients with GLIM-defined malnutrition between 2014 and 2019 at our center were enrolled. The patients were divided into two groups according to the different type of surgery. Propensity score match analysis was used to balance the clinicopathologic characteristics of two groups. Postoperative outcomes and survival were compared. Multivariate analysis was used to independent risk factors of complication, overall survival (OS), and disease-free survival (DFS). Compared with patients underwent open radical gastrectomy, patients who underwent laparoscopic radical gastrectomy had lower rate of total, surgical and severe complications. They also had shorter postoperative hospital stay with better OS and DFS. Hypoalbuminemia (P = 0.003) was the independent risk factor of complications. Old age (≥75, P = 0.035) and TNM stage (III: P < 0.001, II: P = 0.015) were the independent risk factors of OS. Combined resection (P = 0.003) and TNM stage (III: P < 0.001, II: P = 0.001) posed independent risk factors of lacking DFS. Laparoscopic surgery proved to be the independent protective factor of complications (P = 0.014), OS (P < 0.001) and DFS (P < 0.001). Laparoscopic radical gastrectomy was relative safe and showed favorable outcomes in malnourished gastric cancer patients. [ABSTRACT FROM AUTHOR]

The newly released Asian Working Group for Cachexia (AWGC) criteria share similar diagnostic items with the Global Leadership Initiative on Malnutrition (GLIM) criteria. This study aims to compare the AWGC cachexia and GLIM malnutrition in patients with gastric cancer and investigate whether one diagnosis continues to be a prognostic factor in individuals diagnosed with the other condition. Data of patients who underwent radical gastrectomy for gastric adenocarcinoma were prospectively collected from 2013 to 2019. The AWGC and GLIM criteria were applied to diagnosis cachexia and malnutrition, respectively. Univariate and multivariate logistic and Cox regression were used to verify the effect of relevant factors on postoperative complications and overall survival. A total of 1420 patients were included, among whom 174 (12.3 %) were diagnosed with AWGC-cachexia alone, 85 (6.0 %) were diagnosed with GLIM-malnutrition alone, and 324 (22.8 %) had both AWGC-cachexia and GLIM-malnutrition. Both AWGC-cachexia and GLIM-malnutrition were independent risk factors for complications and overall survival. When they coexisted, the odds ratios (OR) and hazard ratios (HR) tended to be higher. In the AWGC-cachexia subset, GLIM-malnutrition remained an independent risk factor (HR = 1.544, 95 % CI = 1.098–2.171, P = 0.012) for overall survival after the adjustment of confounding factors. Similarly, in the GLIM-malnutrition subset, AWGC-cachexia remained an independent risk factor for overall survival (HR = 1.697, 95 % CI = 1.087–2.650, P = 0.020). Patients with both cachexia and malnutrition had the worst overall survival. AWGC-cachexia and GLIM-malnutrition criteria were two non-redundancy tools in reflecting mortality risk in preoperative nutritional assessment. [ABSTRACT FROM AUTHOR]

It is difficult for surgeons to successfully perform closed reduction and percutaneous pinning on displaced and rotated lateral condylar humeral fractures in children. This study aimed to introduce an ultrasound-assisted closed reduction and percutaneous pinning technique and determine its usefulness in the treatment of displaced and rotated lateral condylar humeral fractures in children. Between 2013 and 2018, 42 of 44 displaced and rotated pediatric lateral humeral condylar fractures were successfully treated with ultrasound-assisted closed reduction and percutaneous pinning. All surgical procedures were performed by 1 senior surgeon. Demographic and clinical data including age, sex, affected side, time from injury to reduction, operative time, and number of intraoperative radiographs (without fluoroscopy) were analyzed. Postoperative data were evaluated in terms of Kirschner wire in situ duration, follow-up duration, range of motion, carrying angle, cosmetic result, and complications. The average operative time was 67 minutes from 2013 to 2015 and 51 minutes from 2016 to 2018. All 42 patients who successfully underwent ultrasound-assisted closed reduction were followed up for >3 months, and 31 of 42 patients were followed up for >1 year. Among these 31 patients, the range-of-motion outcomes were excellent in 25 and good in 6. The carrying angle outcomes were excellent in 28 patients and good in 3. Two instances of wire infection, 9 instances of granulation tissue hyperplasia, and 23 instances of lateral spur formation occurred. No nonunion, avascular necrosis, or postoperative nerve issues were identified. The surgical technique of ultrasound-assisted closed reduction and percutaneous pinning presented in this study can effectively help surgeons reduce displaced and rotated lateral condylar humeral fractures in children to avoid some open reductions and achieve satisfactory outcomes. [ABSTRACT FROM AUTHOR]

Background: We investigated associations between timing of sacubitril/valsartan initiation and postdischarge adherence among patients hospitalized for heart failure with reduced ejection fraction (HFrEF). Clinical trials support initiation of sacubitril/valsartan among patients hospitalized with HFrEF. The association between timing of initiation and postdischarge adherence is unknown.Methods and Results: We analyzed patients hospitalized for HFrEF (EF of ≤40%) within the Get With The Guidelines Heart Failure registry linked with Medicare claims between October 2015 and September 2017 who were eligible for sacubitril/valsartan. Follow-up was through December 2018. Patients were grouped by timing of sacubitril/valsartan initiation. Sacubitril/valsartan adherence at 90 and 365 days after discharge was assessed by calculating proportion of days covered (PDC) using medication fills. Among 4666 patients, 108 (2.3%) were continued on sacubitril/valsartan (on sacubitril/valsartan at admission and discharge), 191 (4.1%) were initiated as inpatients, 130 (2.8%) were initiated at discharge, and 4237 (90.1%) were discharged without sacubitril/valsartan. Median (25th, 75th) proportion of days covered through 90 days among those continued, initiated as inpatients, and initiated at discharge was 0.9 (0.6-0.1), 0.3 (0.0-0.7), and 0.0 (0.0-0.7), respectively (P < .001). Patients discharged without sacubitril/valsartan had very low rates of any sacubitril/valsartan fills within 90 and 365 days of discharge (2.1% and 7.7% of surviving patients, respectively).Conclusions: In 2015-2017 US clinical practice, more than 90% of eligible patients hospitalized for HFrEF were discharged without sacubitril/valsartan. Patients initiated as inpatients had a higher postdischarge proportion of days covered than patients initiated at discharge. Patients discharged without sacubitril/valsartan were unlikely to receive it during follow-up. These findings highlight the importance of initiating sacubitril/valsartan during hospitalization to improve the quality of care. [ABSTRACT FROM AUTHOR]

Background The skeletal muscle mass index (SMI) and skeletal muscle radiodensity (SMD) are important components of sarcopenia and malnutrition. However, their assessment requires additional resources in cancer patients, which is inconvenient for the early detection of sarcopenia and malnutrition. Objectives This study aimed to develop and validate nomograms for the prediction of low muscle mass and muscle radiodensity and to examine the application value of the nomograms in the diagnoses of sarcopenia and malnutrition. Methods A total of 1315 patients diagnosed with gastric cancer between July 2014 and May 2019 were included. Random resampling with an 80/20 split ratio was performed to obtain a training cohort (n  = 1056) and a validation cohort (n  = 259). Nomograms were separately constructed for low SMI (LSMI) and low SMD (LSMD) in the training cohort based on prospectively collected preoperative data. The performance of the nomograms was assessed using the AUC, calibration curve, and Hosmer-Lemeshow test. The application values of the nomograms in the diagnoses of sarcopenia and malnutrition were also evaluated. Results Age, BMI, hemoglobin concentration, and gait speed were included in the nomogram for LSMI predictions. These variables, in addition to sex, were included in the nomogram for LSMD predictions. The diagnostic nomograms exhibited good discrimination, with AUCs of 0.818 (95% CI, 0.791−0.845) for the LSMI nomogram and 0.788 (95% CI, 0.761−0.815) for the LSMD diagnostic nomogram in the training cohort. Calibration was also excellent. The agreement ratios between the nomograms and actual observations in the total population were 92.3% and 95.6% for sarcopenia and malnutrition, respectively. Prognostic nomograms exhibited similar performance in the validation cohort. Conclusions Diagnostic nomograms consisting of preoperative factors can successfully predict LSMI and LSMD. These models facilitate early identification and timely interventions for at-risk populations. [ABSTRACT FROM AUTHOR]

Sarcopenia and metabolic syndrome (MetS) are associated with the prognosis from malignant tumors. However, evidence of the relationship between sarcopenia and MetS among gastric cancer (GC) patients following radical gastrectomy is lacking. This study assessed the association between preoperative sarcopenia and MetS among GC patients and analyzed the prognosis of patients with different malnutrition statuses. We prospectively assessed the preoperative statuses of sarcopenia and MetS among patients who underwent radical gastrectomy from July 2014 to December 2017. We combined sarcopenia and MetS to generate four groups: MetS-related sarcopenia group (MSS), sarcopenia group (S), MetS group (MS), and normal group (N). A total of 749 patients with resectable GC were included in this study. Preoperative MetS was associated with sarcopenia (p < 0.001). Multivariate logistic regression presented that MetS-related sarcopenia (OR = 2.445; p = 0.010) and sarcopenia alone (OR = 2.117; p = 0.001) were independent predictors of grade Ⅱ and above complications, while MetS alone was not (p = 0.342). Cox regression analysis revealed that MetS-related sarcopenia led to the worst prognosis in the four groups (MSS vs MS: HR = 3.555, p < 0.001; MSS vs N: HR = 2.020, p = 0.003; MSS vs S: HR = 1.763, p = 0.021). However, the MetS group had better prognosis than the normal group (MS vs N: HR = 0.568, p = 0.048). Preoperative MetS was associated with sarcopenia among GC patients. MetS-related sarcopenia resulted in a significantly worse prognosis. The long-term prognoses of patients with sarcopenia were impaired by preoperative MetS, while patients without sarcopenia benefited. Thus, patients with both sarcopenia and MetS require more medical interventions. • Preoperative MetS was associated with sarcopenia among GC patients. • MetS-related sarcopenia resulted in a significantly worse prognosis. • Prognoses of patients with sarcopenia were impaired by preoperative MetS. • Prognoses of patients without sarcopenia were benefited from MetS. • Patients with both sarcopenia and MetS require more medical interventions. [ABSTRACT FROM AUTHOR]

Introduction: Lateral humeral condyle fracture is one of the most common fractures in children. However, the prediction of the stability of the fracture with a cutoff displacement of 2 mm remains controversial. The aim of this study was to evaluate the reliability of the routine cutoff displacement of 2 mm in predicting the stability of paediatric lateral humeral condyle fractures.Methods: A cohort of 79 children with imaging results for lateral humeral condyle fractures from 2013 to 2019 was evaluated. The displacement on the radiographs was measured by three surgeons at different levels, and ultrasound images were obtained by two senior surgeons. The interobserver and intraobserver reliability was assessed by the intraclass correlation coefficient (ICC). A binary logistic regression model and receiver operating characteristic (ROC) curves were used to evaluate the association between the measurement and the integrity of cartilage hinges.Results: The ICC for the interobserver reliability was 0.85, and the intraobserver reliability was 0.93. For each additional millimetre of displacement, the odds of cartilage hinge disruption increased by 70%. The ROC curve determined that the Youden index was only 0.07 (sensitivity, 97.8%; specificity, 8.8%) with a cutoff displacement of 2 mm.Conclusions: The routine cutoff displacement of 2 mm may not reliably reflect the stability of paediatric lateral humeral condyle fractures. The cutoff value is sensitive but not specific for predicting whether the cartilage hinge is intact. [ABSTRACT FROM AUTHOR]

Radiomics allows for mining of imaging data to examine tissue characteristics non-invasively, which can be used to predict the prognosis of a patient. This study explored the use of imaging techniques to evaluate splenic tissue characteristics to predict the prognosis of patients with gastric cancer. Computed tomography images from patients with gastric cancer were collected retrospectively. Splenic image characteristics, extracted with pyradiomics, of patients in the training group were randomly divided. Characteristics with a P value < 0.1 were selected for lasso regression to construct a survival risk model. Models for high-and low-risk groups were established. Patients were divided into the high- and low-risk groups for univariate and multivariate regression analysis of survival-related factors, and a visual prognostic prediction model was established. The splenic characteristic prognostic model was consistent in the training and verification groups (p < 0.001 and p = 0.016, respectively). The two groups that displayed different splenic characteristics showed no statistical difference in other basic data except the tumour-node-metastasis (pTNM) stage (p = 0.007). Univariate and multivariate analysis of survival risk factors showed that splenic characteristics (p = 0.042), age (p < 0.001), tumor location (p = 0.002), and pTNM stage (p < 0.001) were independent risk factors for survival. The prognostic prediction model combined with splenic characteristics significantly improved the accuracy of prognosis, predicting one-and three-year survival rates. Splenic features extracted from imaging technology can accurately predict the long-term survival of patients with gastric cancer. Splenic characteristic grouping can effectively improve the accuracy of survival prediction and gastric cancer prognosis. [ABSTRACT FROM AUTHOR]

In 2010, the European Working Group on Sarcopenia in Older People (EWGSOP) reached a consensus on sarcopenia (EWGSOP1). In 2018, the EWGSOP met again (EWGSOP2) to update original definition of sarcopenia. This study aimed to investigate the association of sarcopenia and survival and compare the prognostic effects of sarcopenia as defined by EWGSOP1 and EWGSOP2 after gastrectomy. We conducted a prospective study including patients who underwent curative gastrectomy for gastric cancer from August 2014 to February 2018. The sarcopenia elements, including skeletal muscle index, muscle attenuation, handgrip strength, and gait speed were measured before surgery. Patients were followed up after gastrectomy to gain the actual clinical outcomes. The prevalence of sarcopenia was 17.0% and 18.9% according to the EWGSOP1 and EWGSOP2 respectively. Sarcopenia was independent risk factor for postoperative complications. Compared with EWGSOP1-sarcopenia, EWGSOP2-sarcopenia and had a higher odds ratio (OR) (2.453 vs. 1.550) in multivariate model. Area under the ROC curve of model including EWGSOP2-sarcopenia was larger than that of the model including EWGSOP1-sarcopenia (AUC 0.653 vs. 0.634, P = 0.021). For both of EWGSOP1 and EWGSOP2, sarcopenia was an independent risk factor for overall survival (OS) and disease-free survival (DFS), but EWGSOP2-sarcopenia seemed to have a higher hazard ratio (OS, 1.667 vs. 1.449; DFS, 1.603 vs. 1.563). In addition, severe sarcopenia, as defined by either EWGSOP2 or EWGSOP1, had a strong predictive power (OR 4.909 vs. 3.827) for postoperative complications. Both versions of severe sarcopenia were significantly predictive of OS and DFS in Cox analysis. Sarcopenia at uniform diagnosis standard was an independent risk factor for survival in patients undergoing radical gastrectomy for gastric cancer. Sarcopenia defined by EWGSOP2 criteria better predicts clinical outcomes than that defined by EWGSOP1 criteria in patients with gastric cancer after gastrectomy. [ABSTRACT FROM AUTHOR]

The objective of this study is to understand the perceived needs for information on maternal and infant healthcare during the puerperium among the fathers of newborns in China, and to examine factors that are associated with the patterns of perceived needs. A cross-sectional study was conducted. A survey was conducted in the obstetrics department of the First Affiliated Hospital of Soochow University in Suzhou, China. A total of 206 fathers of newborns were interviewed with a response rate of 98.1%. Latent class analysis (LCA) was used to identify a priori unknown patterns of perceived needs for information (knowledge/skills) on maternal and infant healthcare during the puerperium period. Chi-square tests were applied to examine factors associated with such patterns of needs. The majority of the participants perceived strong needs for information on maternal and infant healthcare during the puerperium. LCA identified three latent classes on perceived needs for information on maternal healthcare among Chinese fathers of newborns: Class 1 - Low: Some Infant Health Related Needs; Class 2 - Moderate: Lower Physical Recovery Needs; and Class 3 - High: Enthusiastic Needs. Similarly, three latent classes were identified for perceived needs for information on infant health care: Class 1 - Low: Some Medical Needs; Class 2 - Moderate: Lower Breastfeeding Needs; and Class 3 - High: Enthusiastic Needs. Fathers aged 30 to 35, urban residents, and those with higher education were more likely to be in the Enthusiastic Needs groups for information needs for both maternal and infant healthcare. Perceived needs for information on maternal and infant healthcare are widespread among fathers of newborns in China. Three distinct latent classes for perceived needs for information (knowledge/skills) on maternal and infant health were identified in this population. Socio-demographics, such as age, residence, and education, were significantly associated with such patterns of needs. The findings have implications for the development of interventions to improve maternal and infant healthcare in China. [ABSTRACT FROM AUTHOR]

To investigate whether sarcopenia could predict postoperative outcomes in patients with colorectal cancer with Global Leadership Initiative on Malnutrition (GLIM)-defined malnutrition. Clinical data of patients who underwent radical resection for colorectal cancer were prospectively collected. Sarcopenia was diagnosed by the combination of low handgrip strength and low muscle quantity or quality as measured by abdominal computed tomography (CT) images. Logistic regression analysis and Cox proportional hazards regression analysis were performed to identify independent predictors for postoperative complications and survival, respectively. A total of 310 patients with colorectal cancer with GLIM-defined malnutrition were included, of which 145 (46.77%) were identified with sarcopenia. Malnutritional patients with sarcopenia had significantly higher incidences of total complications (34.5% versus 15.8%), severe complications (9.7% versus 1.8%), longer lengths of postoperative hospital stay (median, 14 days versus 12 days), and more costs (median, 56,257 RMB versus 49,024 RMB) than those without sarcopenia. Sarcopenia was an independent predictive factor for postoperative complications (OR 2.531, 95% CI 1.451–4.415), overall survival (HR 1.519, 95% CI 1.026–2.248), and disease-free survival (HR 1.847, 95% CI 1.324–2.576). Patients with severe sarcopenia had a higher incidence of severe complications but not total complications or survival than those with not-severe sarcopenia. Moreover, the predictive value of sarcopenia for postoperative complications was attributed to muscle strength and quality but not muscle quantity. Sarcopenia predicts postoperative complications and survival in patients with colorectal cancer with GLIM-defined malnutrition. Preoperative assessment of sarcopenia is still necessary when nutritional assessment has been well performed. [ABSTRACT FROM AUTHOR]

Increasing evidence has suggested that sarcopenia is linked with cancer prognosis, but only limited data have focused on the impact of myosteatosis on cancer outcomes. This study evaluates the influence of myosteatosis on postoperative complications and survival in those patients who underwent radical resection of gastric carcinoma. Patients who underwent elective radical gastrectomy for gastric cancer and had computed tomographic images available were identified from a prospectively collected database between 2008 and 2013. Myosteatosis was diagnosed by the cutoff values obtained from the method of optimum stratification. To obtain 2 well-balanced cohorts for available variables influencing clinical outcomes, the myosteatosis group was matched 1:1 with nonmyosteatosis group by using a propensity score match. Of 973 patients, 584 were matched for analyses. Compared with the nonmyosteatosis group, the myosteatosis group manifested significantly higher severe postoperative complications rates, shorter overall survival, and disease-free survival. Before matching, multivariate analyses identified that myosteatosis was an independent risk factor for severe postoperative complications, and Cox proportions hazards model showed that myosteatosis was an independent predictor for shorter overall survival and disease-free survival. In addition, subgroup analyses of each muscle phenotype showed that patients with both sarcopenia and myosteatosis had a poorer overall survival and disease-free survival than other patients. Myosteatosis in gastric cancer is associated with poor prognosis. Classifying the skeletal muscle into subranges of radio density is a promising strategy to understand the impact of skeletal muscle on unfavorable surgical outcomes in gastric cancer patients. [ABSTRACT FROM AUTHOR]

The association between sarcopenia and postoperative outcomes in patients who undergo laparoscopic-assisted gastrectomy is unclear. We aimed to determine the predictive value of sarcopenia for adverse postoperative outcomes after laparoscopic-assisted gastrectomy for gastric cancer. We prospectively collected the clinical data of patients who underwent elective radical laparoscopic-assisted gastrectomy for gastric cancer in two large centers from August 2014 to October 2017. The third lumbar vertebra skeletal muscle index, handgrip strength, and 6-m usual gait speed were measured to diagnose sarcopenia. Subsequently, we aimed to identify the risk factors for postoperative complications. The study included 313 patients and 37 (11.8%) patients were classified as sarcopenic. Compared with non-sarcopenic patients, sarcopenic patients were significantly older (P < 0.001), had higher nutritional risk screening 2002 scores (P = 0.013), Charlson comorbidity index (CCI) scores (P = 0.033), and neutrophil to lymphocyte ratio (P = 0.004), and lower body mass index (P < 0.001), preoperative serum albumin (P < 0.001), and hemoglobin (P < 0.001). Sarcopenic patients had higher postoperative complication rate (P = 0.002), longer postoperative hospital stays (P = 0.020) and higher total cost of hospitalization (P = 0.001). Multivariate analysis revealed that CCI score ≥1 (odds ratio [OR]: 2.424, 95% confidence interval [CI]: 1.309–4.487; P = 0.005) and sarcopenia (OR: 2.752, 95% CI: 1.274–5.944; P = 0.010) were independent risk factors for short-term postoperative complications. Sarcopenia is an independent clinical predictor of short-term postoperative complications after laparoscopic-assisted gastrectomy. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to determine the risk of severe postoperative complications (SPCs) in patients with gastric cancer and to construct a nomogram based on independently related factors to identify high-risk patients.Methods: We conducted a prospective study of 636 consecutive patients with gastric cancer who underwent radical gastrectomy. Degrees of sarcopenia and obesity were calculated before surgery. Factors contributing to SPCs were determined using univariate and multivariate analysis. A nomogram consisting of the independent risk factors was constructed to quantify the individual risk of SPCs.Results: Logistic analysis revealed that sarcopenic obesity, age, open surgery, and combined resection were independent prognostic factors for SPCs. Sarcopenic obese patients have the highest risk in all patients (sarcopenic obesity vs normal, OR = 6.575 p = 0.001; sarcopenic obesity vs obesity, OR = 5.833 p = 0.001; sarcopenic obesity vs sarcopenia, OR = 2.571 p = 0.032), while obese patients share the similar rate of SPCs with normal people (obesity vs normal, OR = 1.056 p = 0.723). The nomogram we constructed was able to quantify the risk of SPCs reliably (c-index, 0.737).Conclusions: Sarcopenic obesity, together with age, open surgery, and combined resection are independent predictors of SPCs. Obesity will significantly increase the risk of SPCs in sarcopenic patient with gastric cancer, but it will not bring higher risk to normal patients. Our nomogram is a simple and practical instrument to identify patients at high risk of surgical complications. [ABSTRACT FROM AUTHOR]

Graphical abstract Highlights • Activated biochar is an effective adsorbent toward 1-naphthol. • The adsorption ability can just be affected by high concentrations of surfactant. • Fluorescence spectra is first utilized in revealing the mechanism among the system. • Surfactant impedes the adsorption of 1-naphthol through multi-interactions. Abstract Removal of polycyclic aromatic hydrocarbons (PAHs) in treated wastewater by adsorbents is a simple and efficient method. However, most of investigations were focused on the adsorption of single pollutant, and little is known about the interference of coexisted pollutants, especially the ubiquitous surfactants. In this study, the interference mechanism of surfactants on biochar adsorption performace to 1-naphthol was investigated by fluorescence spectrum coupling X-ray photoelectron spectroscopy analysis. Although the adsorption performance of activated biochar cannot be hindered by low concentration of surfactant (10 mg/L) both in synthetic and real wastewater, high concentrations of surfactant significantly inhibit the adsorption performance of activated biochar. Fluorescence spectra suggested that a new complex may form by the interaction of SDBS and 1-naphthol, although it could not be structurally identified, which does impede the adsorption of 1-naphthol. Competition of surfactants for the active sites on the adsorbent and replacement of the adsorbed 1-naphthol are other effective factors. [ABSTRACT FROM AUTHOR]

Background: This study aimed to determine the relationship between intra-abdominal infection (IAI) and sarcopenia prospectively and to construct a nomogram to identify patients at a high risk of IAI.Methods: We conducted a prospective study of 682 consecutive patients with gastric cancer who underwent radical gastrectomy. The sarcopenia elements, including lumbar skeletal muscle index, handgrip strength, and gait speed, were measured before surgery. Factors contributing to IAI were determined through univariate and multivariate analysis. A nomogram consisting of the independent risk factors was constructed to quantify the individual risk of IAI.Results: Of the 682 patients enrolled in this study, 132 patients were diagnosed with sarcopenia and 61 were diagnosed with IAI. Logistic analysis revealed that sarcopenia, tumor size, pathological type, and multivisceral resection were independent prognostic factors for IAI. The nomogram model for IAI was able to reliably quantify the risk of IAI with a strong optimism-adjusted discrimination (concordance index, 0.736).Conclusions: Sarcopenia is an independent predictor of IAI. Our nomogram was a simple and practical instrument to quantify the individual risk of IAI and could be used to identify patients at a high risk. [ABSTRACT FROM AUTHOR]

Background The association between sarcopenia and postoperative outcomes has been well reported. However, the impact of different sarcopenia stages on postoperative outcomes has never been investigated. Methods We conducted a large, prospective study of patients who underwent radical gastrectomy for gastric cancer from August 2014 to December 2015. Sarcopenia was staged as “presarcopenia,” “sarcopenia,” and “severe sarcopenia” according to the definition of the European Working Group on Sarcopenia in Older People. Univariate and multivariate analyses evaluating the risk factors for total, surgical, and medical complications were performed. Results A total of 470 patients were included, in which 20.6%, 10%, and 6.8% of the patients were identified as having “presarcopenia,” “sarcopenia,” and “severe sarcopenia,” respectively. Postoperative complications, duration of hospital stays, and costs increased with advancing sarcopenia stages. Severe sarcopenia, visceral fat area to total abdominal muscle area ratio, American Society of Anesthesiologists grade III, and tumor located at the cardia were independent risk factors for total complications. Visceral fat area to total abdominal muscle area ratio and tumor located at the cardia were independent risk factors for operative complications. Presarcopenia, sarcopenia, and severe sarcopenia were all identified as independent risk factors for medical complications, as well as age ≥75 years and Charlson Comorbidity Index. Conclusion Patients had worse postoperative outcomes after gastric cancer operation with advancing sarcopenia stages. Severe sarcopenia, but not presarcopenia or sarcopenia, was an independent risk factor for total postoperative complications. The 3 sarcopenia stages independently influence medical but not surgical complications. Recognizing sarcopenia stages is important for preoperative risk stratification. [ABSTRACT FROM AUTHOR]

Triterpenoid saponins are important bioactive compounds in tea flowers. Using ultra-high performance chromatography coupled with electrospray ionization quadrupole time-of-flight mass spectrometry, a total of 21 triterpenoid saponins were identified and characterized from tea flower extracts of selected cultivars from Zhejiang province. A comparison of the seven main saponins was performed in the four main Zhejiang tea flower samples at different developmental stages. High accumulation of saponins at the early stages was observed in all tea flower cultivars. This may be explained, at least partly, by the high levels of saponins in petals at the green bud stage, when petals constitute over 50% of the whole flower weight. Floratheasaponin A and floratheasaponin D were the most abundant saponins in the flowers of Longjing NO.43, Baiye NO.1, and Jiaming NO.1, which is similar to results with tea flowers from Anhui province. Considerable amounts of chakasaponins I and II were found in Yingshuang flowers, as in the parent cultivar, Fudingdabai, and tea flowers from Fujian province. The quantified saponins profiles were analyzed by principal component analysis (PCA) and hierarchical clustering analysis (HCA) and successfully discriminated between all tea flower samples. [ABSTRACT FROM AUTHOR]

Objective: to examine the psychometric properties of a newly developed Postpartum Women's Health Quotient Scale (PWHQS) for Chinese post partum women. Design: a cross-sectional survey of post partum women was conducted. Categorical confirmatory factor analysis (CCFA) models were applied to examine the factorial structure of the PWHQS; test information function (TIF) was used to examine reliability of PWHQS subscales; and measurement invariance was examined by testing differential item functioning (DIF) using a multiple indicators multiple causes (MIMIC) model. Setting: two large hospitals with a level 3A designation in Suzhou, Jiangsu Province, China. Participants: a convenience sample of 395 post partum women was recruited from April to September 2014. Measurement: the PWHQS consists of 31 items with 5 subscales: health consciousness (HC, 6 items), maternal health knowledge (MHK, 8 items), infant health knowledge (IHK, 6 items), maternal health care ability (MHCA, 5 items), and infant health care ability (IHCA, 6 items). Findings: PWHQS has a valid factorial structure with five dimensions as theoretically designed. Each of its subscales has adequate reliability that is particularly high over the lower-moderate range of the factor score scale. Measurement non-invariance in PWHQS is very limited as only two of the 31 items displayed DIF related to one grouping variable (Age). Key conclusion: PWHQS is a valid and reliable instrument that can be readily used as a screening tool to assess health quotient (HQ) among Chinese post partum women. PWHQS will also be useful for the development of interventions to help post partum women maintain and improve maternal and infant health. Further research to confirm the findings of the present study is desirable. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to evaluate the short- and long-term outcomes after total gastrectomy (TG) with D2 lymphadenectomy.Methods: Patients undergoing TG with D2 lymphadenectomy for gastric cancer between December 2008 and December 2011 were enrolled. Univariate and multivariate analyses were performed to evaluate the risk factors for the short- and long-term outcomes.Results: A total of 229 patients were analyzed, and 22.3 % developed complications within 30 days of surgery. No patient died within 30 days, while 2.6 % died within 90 days of the operation. In the multivariate analysis, age ≥65 years and cardiopulmonary comorbidities were associated with morbidity, whereas hypoproteinemia and tumor-node-metastasis (TNM) stage III were associated with the disease-free survival (DFS) and overall survival (OS). The number of preoperative risk factors stratified the morbidity from 10.3 % in those without any risk factors to 40.5 % in patients with both risk factors. Similarly, 5-year survival rates decreased from 68.9 % (DFS) and 71.1 % (OS) in those without risk factors to 20.2 % (DFS) and 22.9 % (OS) in patients with both risk factors.Conclusion: TG with D2 lymphadenectomy has acceptable short- and long-term outcomes. Patient risk stratification may allow for more rational selection of patients and therapeutic strategies for gastric resection. [ABSTRACT FROM AUTHOR]

Transmembrane protease serine 4 (TMPRSS4) is a type-II transmembrane serine protease that is frequently upregulated in human cancers. However, little is known about the biological roles of TMPRSS4 in gastric cancer. In this study, we examined the effect of TMPRSS4 on gastric cancer cell proliferation, migration, and invasion. The expression and secretion of matrix metalloproteinase-9 (MMP-9) and activation of nuclear factor-κB (NF-κB) were determined. The involvement of NF-κB/MMP-9 signaling was checked. Our data showed that TMPRSS4 silencing significantly ( P < 0.05) reduced the migration and invasion of AGS and MKN-45 gastric cancer cells, without affecting cell proliferation. Overexpression of TMPRSS4 significantly promoted cell migration and invasion. The expression and secretion of MMP-9 was significantly ( P < 0.05) enhanced in TMPRSS4-overexpressing cells. TMPRSS4-overexpressing cells had a significantly ( P < 0.05) lower level of IκBα and higher level of nuclear NF-κB. Luciferase reporter assay confirmed that overexpression of TMPRSS4 resulted in a 3–5-fold increase in NF-κB-dependent luciferase activity. Downregulation of MMP-9 significantly ( P < 0.05) reversed the invasiveness of gastric cancer cells induced by TMPRSS4 overexpression. Moreover, pharmacological inhibition of NF-κB attenuated the invasion of TMPRSS4-overexpressing cells and the expression of MMP-9. Upregulation of TMPRSS4 enhances the invasiveness of gastric cancer cells, largely through activation of NF-κB and induction of MMP-9 expression. Our study provides the rationale for targeting TMPRSS4 in the treatment of gastric cancer. [ABSTRACT FROM AUTHOR]

Health outcomes- all-cause hospitalization (hosp), HF hosp, HF-related emergency dept. (ED) visits and a composite of all 3 outcomes provide important information about the benefits of using pharmacological therapy in patients with HF. It is important to assess real-world outcomes after Food and Drug Admin. indication expansion of sacubitril/valsartan (sac/val). Patients treated with sac/val vs. ACEi/ARB will have improved post-index date 6-month hosp and ED visit health outcomes. Within 12 hospitals and over 100 outpatient practices (OPD) in OH and FL within a large healthcare system, adult patients prescribed sac/val between August 2015 through July 2018 were matched to patients prescribed ACEi/ARB (based on age, sex, EF, comorbidity status, index date, hospital vs. OPD index date and systolic BP) and health outcomes were assessed. Differences in outcomes of sac/val treated vs. matched ACEi/ARB controls were compared using linear, logistic, and Poisson models with generalized estimating equations. Of 3588 patients (1794 per group), 3413 (95.1%) had sac/val initiated in OPD. Baseline mean (SD) age was 64.2 (13.0) yrs, 70.3% were male, 20.7% were Black, mean systolic BP was 122.1 (16.1) mmHg, mean NTproBNP (n=2574) was 3732.4 (6453.0) pg/mL and estimated glomerular filtration rate (eGFR) was normal (>60 ml/min/1,732) in 76.2% of patients and of those with kidney dysfunction, the mean was 47.3 (12.1) ml/min/1,732. By HF factors, 40.2% had dilated cardiomyopathy and 47.6% were NYHA-functional class II. Mean EF% was 29.0 (9.9) but spanned from under 10% (2.4%) to 60% with 90.3% as HFrEF and 349 (9.7%) as HFmidrangeEF. Of medications, 92.4% were on beta-blocker, 43% were on a mineralocorticoid receptor antagonist and 63.1% were on a loop diuretic. From baseline to 6 months, 50 patients died (16 sac/val vs. 34 ACEi/ARB; p =0.011). At 6-month assessment, sac/val use was associated with lower rates of all-cause and HF hosp, HF ED visits and the composite outcome (all p <0.001); see Figure of event rate (%) odds ratios. Among a heterogenous sample of patients with HF (EFs spanned from 10-60%), utilization of sac/val was associated with fewer deaths at 6 months and improvement in 6-month all-cause and HF hosp, HF-related ED visits and the composite outcome. In future analyses, it will be important to determine patient and provider factors that facilitated sac/val use and improved clinical outcomes. [ABSTRACT FROM AUTHOR]

There are limited data on the use of angiotensin receptor-neprilysin inhibitors (ARNI) in minority demographic populations with heart failure with reduced ejection fraction (HFrEF). We used data from CHAMP-HF to describe ARNI use and associated health status and clinical outcomes across different races and ethnicities. CHAMP-HF was a prospective, observational cohort registry of outpatients in the United States with chronic HFrEF. We compared patients starting ARNI therapy to those not starting ARNI using a propensity-matched analysis. Patients were grouped as Hispanic or Non-Hispanic Black, Non-Hispanic White, or Non-Hispanic Other. Health status was assessed using the 12-item Kansas City Cardiomyopathy Questionnaire (KCCQ), calculated from pre-match KCCQ score and post-match KCCQ score at least two weeks after the match. Outcomes were analyzed with multivariable models that included race/ethnicity group, ARNI use, and an interaction term between race/ethnicity and ARNI use. Cox proportional hazards models were used for death and HF hospitalization and multiple regression was used for change in KCCQ score. 1,516 patients from the CHAMP-HF registry were included, with 758 patients in each group (ARNI and no-ARNI). Changes in KCCQ score before and after ARNI initiation were similar among all race/ethnicity groups studied, including Hispanic and non-Hispanic Black patients. There was no significant interaction between race/ethnicity and ARNI use for change in KCCQ score (Table). In addition, there was no statistically significant interaction between race/ethnicity and ARNI use for HF hospitalization (P=0.82) or all-cause mortality (P=0.92). In a large registry of outpatients with HFrEF, the association between ARNI initiation and outcomes, including changes in health status, did not differ by race and ethnicity. These data support the use of ARNI therapy for chronic HFrEF irrespective of race and ethnicity. [ABSTRACT FROM AUTHOR]

Abstract: This study was conducted to develop and characterize a novel cytoplasmic male sterile (CMS) source which was identified from Dongxiang wild rice (Oryza rufipogon) by crossing Dongxiang wild rice as female with Zhongzao 35, an indica inbred variety, as male and continuous backcrossing with Zhongzao 35. Observation under optical microscope manifested that this novel CMS belonged to typical abortion type with less pollen compared with wild abortive type cytoplasm (CMS-WA). Sequential planting showed that this novel CMS has complete and stable male sterility. Testcross experiment showed that all the 24 tested materials including maintainer and restorer lines of CMS-WA and Honglian type cytoplasm (CMS-HL) and other indica inbred varieties are the maintainers with complete maintaining ability, suggesting that this novel CMS has fertility restoration totally different from CMS-WA and CMS-HL and belongs to a novel type of CMS. So far, we only discovered a unique fertility restoration source for this novel CMS. Inheritance analysis showed that the fertility restoration of this CMS was governed by three pairs of independent dominant genes. Prospect for application of this novel CMS system in hybrid rice breeding was also discussed. [Copyright &y& Elsevier]

Abstract: Paeoniae radix is a traditional Chinese medicinal herb for treating some diseases; important components are total paeony glycosides (TPGs), an approved drug by the State Food and Drug Administration (SFDA) for the therapy of rheumatoid arthritis (RA). We firstly reported myocardial benefits of TPGs previously, and the present study is to further investigate the underlying mechanisms for preventing oxidative damage in cardiomyopathy. We measured the capacity of TPGs to scavenge free radicals in vitro. Then 60 SD rats were randomly divided into five groups: (1) a normal control group, (2) an isoprenaline (ISO)-induced myocardial ischemic model group, (3) a TPG treatment group (TPGs 269.4mg/kg delivered by intragastric administration for 3 days before ISO administration and TPGs 449mg/kg delivered for 3 days after ISO administration), (4) a TPG therapy group (TPGs 449mg/kg delivered for 3 days after ISO administration), and (5) a positive control group (propranolol 15mg/kg for 3 days after ISO administration). The ISO-induced myocardial ischemic model was established by subcutaneous injection of 1mg/kg/8h ISO (2 times). The activities of myocardial enzymes, including glutamic oxaloacetic transaminase (GOT), creatine kinase (CK), lactate dehydrogenase (LDH), antioxidant enzyme superoxide dismutase (SOD) as well as the content of lipid peroxidation product malondialdehyde (MDA) were detected. We found that TPGs potently eliminated hydroxyl radicals and superoxide in vitro using ESR assays. Compared with model rats, TPG treatment, TPG therapy and the positive control treatment exhibited significantly reduced activities of GOT, LDH, and CK (p <0.01), increased activity of SOD (p <0.01) and lower levels of MDA (p <0.05). More interestingly, the protective effect of TPG treatment was even better than that of propranolol. These results suggest that TPGs significantly ameliorate ISO-induced myocardial ischemia and their action might be through reducing oxidative stress in ischemic myocardium. [Copyright &y& Elsevier]

Abstract: Cu, Ag and Pt added La0.6Sr0.4Co0.2Fe0.8O3−δ (LSCF) and gadolinia-doped ceria (GDC) were analyzed by the temperature-programmed techniques for their characteristics as either the cathode or the anode of the solid oxide fuel cells (SOFCs). Temperature-programmed oxidation using CO2 was used to characterize the cathode materials while temperature-programmed reduction (TPR) using H2 and TPR using CO were used to characterize the anode materials. These techniques can offer an easy screening of the materials as the SOFC electrodes. The effects of adding Cu, Ag and Pt to LSCF for the cathodic reduction activity and the anodic oxidation activity are different—Cu>Ag>Pt for reduction and Pt>Cu>Ag for oxidation. The CO oxidation activities are higher than the H2 oxidation activities. Adding GDC to LSCF can increase both reduction and oxidation activities. The LSCF–GDC composite has a maximum activity for either reduction or oxidation when LSCF/GDC is 2 in weight. [Copyright &y& Elsevier]