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Abstract Background In patients with stage IV colorectal cancer (CRC), minimally invasive surgery (MIS) may offer optimal oncologic outcome with low morbidity. However, the relative benefit of MIS compared to open surgery in patients requiring multistage resections has not been evaluated. Methods Patients who underwent totally minimally invasive (TMI) or totally open (TO) resections of CRC primary and liver metastases (CLM) in 2009–2016 were analyzed. Inverse probability of weighted adjustment by propensity score was performed before analyzing risk factors for complications and survival. Results The study included 43 TMI and 121 TO patients. Before and after adjustment, TMI patients had significantly less cumulated postoperative complications (41% vs. 59%, p = 0.001), blood loss (median 100 vs. 200 ml, p = 0.001) and shorter length of hospital stay (median 4.5 vs. 6.0 days, p < 0.001). Multivariate analysis identified TO approach vs. MIS (OR = 2.4, p < 0.001), major liver resection (OR = 4.4, p < 0.001), and multiple CLM (OR = 2.3, p = 0.001) as independent risk factors for complications. 5-year overall survival was comparable (81% vs 68%, p = 0.59). Conclusion In patients with CRC undergoing multistage surgical treatment, MIS resection contributes to optimal perioperative outcomes without compromise in oncologic outcomes. Synopsis: A coordinated preplanned approach to total laparoscopic multistage resection of stage IV colorectal cancer optimizes short-term outcomes. [ABSTRACT FROM AUTHOR]

Compared with single-stage latent heat storage, cascaded latent heat storage is considered as an effective way to store and utilize intermittent or fluctuant thermal energy due to an increased heat transfer rate, a uniform and lower HTF outlet temperature, faster charging/discharging processes and higher exergy efficiency. In this paper, an experimental three-stage latent heat storage system filled with three different phase change materials is established and its heat charging process is studied. Its temperature evolution in each stage during the heat charging process is measured and the corresponding thermodynamic performance is analyzed. Besides, the effects of stage number, HTF inlet temperature and HTF flow rates on the thermodynamic performance are discussed, respectively. The results show that the solid-liquid phase change in the three stages does not take place simultaneously due to the poor heat transfer and the large melting temperature difference. In addition, more stages could improve energy storage efficiency, exergy storage efficiency and entransy storage efficiency. Higher HTF inlet temperatures and larger HTF flow rates could increase transfer and storage rates of energy, exergy and entransy, but the storage efficiency of energy, exergy and entransy could only be obviously improved by higher HTF inlet temperatures. [ABSTRACT FROM AUTHOR]

Changes in the complexity of natural organic matter (NOM) have impacted the performance of direct filtration plants of water industries, resulting in reduced treatment capacity, and can lead to increased disinfection by-products. Hence, the need to identify new materials in future can be converted into more effective technologies and processes. We report a laboratory scale innovative use of graphene oxide membranes to remove NOMs from water that had been treated and still contained 5 mg/L DOC. Our study shows that graphene oxide based membranes can reject ∼100% of NOM while maintaining high water flux of 65 L m −2 h −1 bar −1 at atmospheric pressure. Our results indicate that it is possible to develop a graphene oxide-based water filtration technology. [ABSTRACT FROM AUTHOR]

Advances in molecular biology have enabled identification of tumor biomarkers that allow for individualized risk assessment for patients with cancer. Molecular predictors of clinical outcome can help inform discussion regarding the role of adjuvant chemotherapy in patients with resected colon cancer, such as those with stage II colon cancer in which the benefit of adjuvant therapy is controversial or those with stage III colon cancer who may have a lower risk of recurrence and less absolute benefit from oxaliplatin therapy. This article summarizes the data surrounding the development, validation, and clinical and economic utility of the Oncotype DX® colon cancer assay, a multigene expression assay validated to independently predict recurrence risk in patients with stage II and III colon cancer beyond traditional factors. [ABSTRACT FROM AUTHOR]

Taro ( Colocasia esculenta ) is an important crop in Africa, Southeast Asia and the subtropics, as it is used for food and medicine. The aims of this study were to access a large expression datasets of taro and reveal the candidate genes of starch synthesis. As a result, approximately 2.2 Gb sequence data of taro transcriptome were obtained by using Illumina HiSeq 2000 platform and assembled into 52,935 contigs with an average length of 588.5 bp. Sequence similarity analyses against four public databases (NR, GO, KEGG, KOG) found 17,047 contigs that could be annotated with gene descriptions, conserved protein domains, or gene ontology terms. Among the important metabolic pathways, 26 genes related to starch synthesis were validated by RT-PCR. This transcriptome dataset can serve as an important public information platform for further studies in gene expression, genomics, and functional genomic studies in C. esculenta . [ABSTRACT FROM AUTHOR]

Purpose: Definitive radiation therapy with concurrent chemotherapy is curative for nonmetastatic squamous cell carcinoma of the anus (SCCA). However, the true effect of chemoradiation on long-term functional outcomes is poorly understood owing to limited follow-up and patient-reported outcomes (PROs).Methods and Materials: We conducted a cross-sectional survey of 248 patients with SCCA treated with definitive intensity modulated radiation and concurrent chemotherapy from 2010 to 2018 who were alive and without recurrence. PRO measures were collected, including Functional Assessment of Cancer Therapy-General (FACT-G7), Fecal Incontinence Quality of Life (FIQoL), Low Anterior Resection Syndrome (LARS), and International Consultation on Incontinence Questionnaires (ICIQ). Models were used to determine the association between demographic, tumor, treatment, and dosimetric data with PROs.Results: One hundred twelve (45%) patients completed PROs. Median [interquartile range (IQR)] time from radiation completion to survey was 51 [37-85] months. The median scores [IQR] for FACT-G7, FIQoL, and LARS were 21 [15-24], 14 [11-16], and 32 [25-37], respectively. For men, median subscores [IQR] for ICIQ voiding and incontinence subscores were 5 [2-6] and 1 [1-3], respectively. For women, median subscores [IQR] for ICIQ voiding, incontinence, and filling were 1 [1-3], 5 [3-8], and 4 [2-5], respectively. Higher (better) FIQoL scores were associated with higher (better) FACT-G7 scores (β = 0.83; 95% confidence interval, 0.58-1.09; P < .001), and higher (worse) LARS scores were associated with lower (worse) FACT-G7 scores (β = -0.22; 95% confidence interval, -0.31 to -0.13; P < .001). A separate multivariable analysis revealed higher bowel bag D1% was associated with lower (worse) FIQoL (P = .001) and higher (worse) LARS (P = .003) scores. Higher bladder V40 Gy was associated with increased (worse) ICIQ voiding subscore (P = .001).Conclusions: Patients treated with modern chemoradiation for SCCA experience significant long-term bowel toxic effects with considerable effect on quality of life. Minimizing bowel hotspots and bladder V40 Gy may improve bowel and urinary function. Other interventions to reduce long-term toxic effects and improve quality of life are needed. [ABSTRACT FROM AUTHOR]

By using the first-principles calculations within virtual crystal approximation (VCA) framework, the alloying behavior of transition metals M (M = Cr, Ni, Mo, V, Co, Nb, Mn, Ti and Cu) has been investigated in ternary ε-(Fe 1 − x M x ) 3 N nitrides ( x = 0–0.15). The phase stability and elastic properties are studied by calculating the formation Gibbs energy, independent elastic constants and densities of states. The calculated results show that the stability of the ε-(Fe 1− x M x ) 3 N nitrides decrease with the increase of the substitution content, indicating the decomposition of ε phase to α or γ′ phases. The elastic properties of the ε-(Fe 1− x M x ) 3 N nitrides are sensitive to the transition element types except Co and Mn which show the weakest effect. Densities of states are given for all ε-(Fe 1− x M x ) 3 N nitrides to confirm the origins of the variations of phase stability and elastic properties. The calculated results show a reasonable agreement with available experimental values. [ABSTRACT FROM AUTHOR]

• This study examined outcomes of panel testing of colorectal cancer genes in patients with colorectal cancer at 35 or younger. • The results confirmed a previous study showing a high incidence of hereditary colorectal cancer syndromes in young patients. • Disease-specific panel testing did not increase the yield of diagnostic workup over phenotype-driven testing. • Broader panels may increase the yield but also identify more uncertain variants in young patients with colorectal cancer. Adolescents and young adults with colorectal cancer (CRC) have attracted recent attention, with a hereditary syndrome identified in one-third of patients diagnosed ≤ 35. We aimed to study this population to determine if a CRC-specific gene panel increased the yield of testing. Patients with CRC ≤ 35 evaluated from 05/2014–11/2017 were identified from the genetic counseling database. Records were reviewed for personal/family history and genetic counseling outcomes. One hundred forty-three patients with CRC ≤ 35 were included. One hundred four (72.7%) underwent CRC panel testing. Thirty-nine (27.2%) had syndrome-directed testing, declined, or were lost to follow-up. Forty-two patients had a genetic syndrome (29.4%). Twenty-four of the 42 hereditary patients (57.1%) were identified via syndrome-directed testing. Mutations identified via panel testing were consistent with patient personal/family history. Thirty-three patients had at least one variant of uncertain significance. Hereditary syndromes were identified in 29.4% of patients. Panel testing in patients without a phenotype did not increase diagnostic yield, but identified variants in one-third. Disease-specific panel testing is of low yield in young patients without a suggestive personal/family history. Testing broader panels may increase the yield of mutation pick-up in this population, although at the expense of identifying variants. [ABSTRACT FROM AUTHOR]

Despite the availability of effective colorectal cancer (CRC) screening strategies, up to 10% of CRC patients present with obstructive symptoms as the first sign of disease. For patients with acute or subacute malignant obstruction that requires urgent intervention, treatment options include endoscopic stenting as a bridge to surgery, one-stage surgical resection and anastomosis, or diverting ostomy which may or may not be followed by later tumor resection and stoma closure. However, to date, there is no consensus guideline for the optimal approach to manage malignant colorectal obstruction. This article aims to illustrate clinical scenarios in palliative, curative, and potentially curative settings, and delineate the key factors to be considered when making an individualized decision in order to determine the optimal treatment. [ABSTRACT FROM AUTHOR]

Background Uncontrolled infections are known to be an absolute contraindication for liver transplantation; however, the posttransplant prognosis of recipients treated for pretransplant infection is unclear. The aim of this study was to analyze pretransplant infections among liver transplant recipients and to determine their impact on posttransplant clinical outcomes. Methods This study retrospectively analyzed 357 subjects who had undergone living-donor liver transplantation between January 2008 and May 2014. Results Among 357 recipients, 71 patients (19.8%) had 74 episodes of infectious complications before liver transplantation. These complications consisted of pneumonia (n = 13), spontaneous bacterial peritonitis (n = 12), catheter-related infection (n = 10), urinary tract infection (n = 12), biliary tract infection (n = 6), and skin and soft-tissue infection (n = 3). Twenty-six patients experienced 29 episodes of bacteremia, and the most common pathogens were coagulase-negative staphylococci (n = 8), followed by Klebsiella pneumoniae (n = 7), Staphylococcus aureus (n = 4), and Streptococcus species (n = 3). Twenty-one bacteremic episodes (70%) occurred within 1 month before transplantation (n = 4). Recipients with pretransplant infections had significantly more frequent posttransplant infections (71.8% [51 of 71] vs 47.2% [35 of 286]; P = .0001), posttransplant bacteremia (33.8% [24 of 71] vs 20.3% [58 of 286]; P = .015), and longer posttransplant intensive care unit stays (11.2 ± 10.7 days vs 7.3 ± 4.2 days; P = .0004) than those without pretransplant infections. However, episodes of rejection ( P = .36), length of hospitalization ( P = .10), 28-day mortality ( P = .31), and 1-year mortality ( P = .61) after transplantation were not significantly different between the 2 groups. Conclusions Pretransplant infection had an impact on posttransplant morbidity, although not on rejection and mortality. Alertness for posttransplant infection and proper management (including effective antimicrobial coverage) would improve patient morbidity. [ABSTRACT FROM AUTHOR]

Background Acinetobacter baumannii has become an increasingly important nosocomial pathogen. Carbapenem is the preferred drug of choice for treatment of multidrug-resistant gram-negative bacilli, but carbapenem-resistant A baumannii (CRAB) has now emerged. The aim of this study was to determine the incidence, outcomes, and risk factors for CRAB bacteremia in liver transplant recipients. Methods The medical records of 393 subjects who underwent living donor liver transplant at Seoul St. Mary's Hospital from January 2008 to April 2015 were reviewed. Results A total of 92 (23.4%) bacteremic patients, comprising 156 episodes, were identified. Fourteen patients, totaling 18 episodes, had CRAB bacteremia. The median time of emergence of CRAB bacteremia was 55.5 (range, 2–829) days after transplantation, and 72.2% of episodes (n = 13) occurred within 6 months of transplant. The presumed sources of infection were intra-abdominal (n = 11, 61.1%), biliary tract (n = 3, 16.7%), lung (n = 2, 11.1%), catheter (n = 1, 5.6%), and wound (n = 1, 5.6%). By multivariate analysis, length of post-transplant intensive care unit (ICU) stay (odds ratio [OR], 1.1, 95% confidence interval [CI], 1.11–1.15; P = .04) was associated with CRAB bacteremia. Overall mortality in 14 recipients with CRAB bacteremia was 50% (n = 7), but only 10% (30 of 301) in non-bacteremic patients and 20.5% (16 of 78) in other bacteremic patients excluding CRAB ( P < .001). Conclusion In our study, patients with CRAB bacteremia after liver transplant showed an unfavorable outcome and, recently, CRAB has become an increasingly major pathogen at our center. Reducing the length of ICU stay could be a solution for preventing CRAB bacteremia. [ABSTRACT FROM AUTHOR]

Blockage of cohesive fine particles in a packed structure of large particles may happen in many industrial processes, of particular interests to ironmaking COREX technology. In this work, blockage behaviour of cohesive fine particles in a simplified packing structure is studied by means of discrete element method. The typical phenomena about effects of sticking force on descending velocity and blockage frequency is described. Two kinds of blockage mechanisms of fine particles in a packed bed of large particles are explored: mechanical interactions between fine particles will create arches on the pore throat and stop the flow; fine particles with high interparticle stickiness will adhere to the surface near the pore throat of the orifice, thus the sectional area of the flow channel will decrease. With the increase of sticking force, the descending velocity will decrease, while the frequency of the blockage increases. In addition, the effects of size ratio of fine particle to packing particle, mass flow rate and magnitude of the upward force (e.g. from a gas stream) on blockage behaviour are also discussed. The results show that increasing the size ratio, mass flow rate and external force will increase the frequency of the blockage. The study provides a fundamental understanding on blockage behaviour of cohesive fine particles in a packed bed, and is useful for industry processes' understanding and optimization. [ABSTRACT FROM AUTHOR]

Glioblastoma is the most prevalent and lethal primary intrinsic tumor in the central nervous system. Glioblastoma stem cells (GSCs) reprogram the transcriptional and metabolic machinery to mediate therapeutic resistance to radiation. Understanding the regulatory mechanism of GSCs may inform novel approaches to improve the clinical outcome for glioblastoma patients. Nuclear pore complex (NPC) is an evolutionarily conserved structure that maintains the traffic between the nucleus and cytoplasm. In current study, we aim to interrogate the aberrant regulation of NPC in GSCs and develop novel targeted approach to sensitize GSC to radiation. Patient-derived GSCs were validated using functional assays. Transcriptional analysis of GSCs and matched differentiated glioblastoma cells (DGCs) were performed using RNA sequencing to identify aberrant regulatory pathways upregulated in GSCs. The clinical impact of target genes on patient survival was assessed using the glioblastoma dataset from The Cancer Genome Atlas (TCGA). Quantitative RT-PCR and Western blotting were performed to assess the relative expression between GSCs and DGCs. Radiation sensitivity was measured using Cs-137 irradiator. Validation of the stem-like function of target genes was performed using RNA interference followed by in vitro neurosphere formation assay and in vivo tumorigenesis with xenograft mouse model. 27 of the total 31 NPC genes were found to be upregulated in the primary glioblastoma patient specimens compared to non-tumor brain tissue in the TCGA dataset. Among them, a systematic approach combining transcriptional profiling and clinical validation linked nucleoporin 98 (NUP98) to a nexus between GSC phenotype and radiation resistance. GSCs preferentially express NUP98, which is essential for GSC maintenance and tumorigenesis in vitro and in vivo. RNA sequencing demonstrated that NUP98 regulates the expression of key DNA repair genes, including BRCA1, BRCA2, and RAD51. NUP98 forms a complex with the transcription factor P65, and directly stimulates the active transcription of genes involved in homologous recombination. Attenuation of NUP98 or P65 expression leads to the accumulation of unrepaired intrinsic DNA damage and sensitizes GSC to the treatment of ionizing radiation. Clinically, overexpression of NUP98 informs poor clinical outcome among patients with glioblastoma. Combining transcriptional discovery and clinical validation, we discovered that NUP98, an essential NPC component, maintains GSC proliferation and tumorigenesis through modulating the transcriptional control of homologous recombination pathway. Our results demonstrated a novel therapeutic approach of sensitizing GSC to radiation through targeting the nexus between aberrant transcriptional regulation and therapeutic resistance in stem-like glioma cells. [ABSTRACT FROM AUTHOR]

In this study, we prepared a kind of composite solid polymer electrolyte (CSPE) based on montmorillonite (MMT) nano-clay fillers, lithium-bis(trifluoromethanelsulfonyl) (LiTFSI), polyvinylidenedifluoride (PVDF) and polyvinyl alcohol (PVA) copolymer by the casting method. Effect of the montmorillonite on ionic conductivity and electrochemical properties of the polymer electrolyte was demonstrated. The result CSPE obtained a higher ionic conductivity up to 4.31 × 10 −4 S cm −1 at room temperature when 4.0 wt% MMT was contained, and the maximum lithium ions transference number of 0.40 was achieved. Electrochemical performance of the polymer solid electrolyte was evaluated in Li/polymer electrolyte/LiFePO 4 coin cell. Good performance with low capacity fading on charge–discharge cycling was achieved, indicating the potential application of the as-prepared CSPE in lithium ion batteries. [ABSTRACT FROM AUTHOR]

Background: With advances in multimodality therapy, colorectal cancer survivors are living longer. However, little is known about the quality of their long-term survival. We investigated the functional outcomes and symptoms among long-term survivors. Methods: A cross-sectional study of 1,215 long-term (>5 years) colorectal cancer survivors was conducted using a validated disease-specific questionnaire. Younger onset survivors (18-50 years) were matched 1:2 to later onset survivors (>50 years). Standardized mean scores were compared using one-way ANOVA. Key patient and treatment factors that impact function and symptoms were assessed by multivariate linear regression. Results: Eight hundred thirty survivors responded at an interval of 10.8 ± 3 years from diagnosis (68 % response rate). Younger onset survivors underwent more surgery (97.9 vs. 93.6 %, P < 0.001) and received more chemotherapy (86.1 vs. 77.7 %, P = 0.004). Anxiety, body image, sexual dysfunction, embarrassment by bowel movements, micturition problems, and impotence were significant concerns. Younger onset survivors reported worse anxiety, body image, and embarrassment with bowel movements, whereas later onset survivors highlighted sexual dysfunction, micturition problems, and impotence. Age at diagnosis was a key independent determinant of long-term function and symptoms. Conclusion: Long-term survivors of CRC face ongoing functional deficits and symptoms, and their survivorship experience differs by age. Age at diagnosis should serve as a basis for tailored, personalized survivorship care plans. [ABSTRACT FROM AUTHOR]

In this study, plasma nitrocarburizing at various temperatures in the range of 460–540 °C were carried out on M50NiL steel in order to improve wear properties. The nitrocarburizing temperature was optimized to obtain the best wear properties. The phase composition, microstucture and microhardness profiles of nitrocarburized layers of M50NiL steel were characterized by XRD, optical microscope and Vickers microhardness measurements, respectively. Pin-on-disc tribometer and SEM equipped with EDS were applied to measure friction and wear properties and analyze wear mechanisms involved. XRD results show that the amount of ɛ-Fe 2-3 (N,C) phase increased as the nitrocarburizing temperature rose form 460 °C to 500 °C and then decreased at 540 °C, while the amount of γ′-Fe 4 (N,C) phase increased as the treatment temperature rose. The hardness of the nitrocarburized layers showed an obvious improvement accompanied with the increasing nitrocarburizing temperature, and obtained the maximum surface hardness of 1287 HV at 540 °C. The results of wear tests carried out at various sliding speeds indicated that the wear mechanism depends on sliding speed rather than the nitrocarburizing temperature. With the increase of the sliding speed, the wear mechanism transfers from oxidation mode to abrasive mode. The gradually deceased wear rate of the specimen nitrocarburized at 500 °C with the increase of the sliding speed indicated the excellent wear resistance under high sliding speed condition. Therefore, 500 °C can be selected as an optimized nitrocarburizing temperature for M50NiL steel. [ABSTRACT FROM AUTHOR]

Aim: To differentiate glioblastoma (GBM) from solitary brain metastases (MET) using radiomic analysis.Materials and Methods: Two hundred and fifty-three patients with solitary brain tumours (157 GBM and 98 solitary brain MET) were split into a training cohort (n=178) and a validation cohort (n=77) by stratified sampling using computer-generated random numbers at a ratio of 7:3. After feature extraction, minimum redundancy maximum relevance (mRMR) and the least absolute shrinkage and selection operator (LASSO) were used to build the radiomics signature on the training cohort and validation cohort. Performance was assessed by radiomics score (Rad-score), receiver operating characteristic (ROC) curve, calibration, and clinical usefulness.Results: Eleven radiomic features were selected as significant features in the training cohort. The Rad-score was significantly associated with the differentiation between GBM and solitary brain MET (p<0.001) both in the training and validation cohorts. The radiomics signature yielded area under the curve (AUC) values of 0.82 and 0.81 in the training and validation cohorts to distinguish between GBM and solitary brain MET.Conclusions: The radiomics model might be a useful supporting tool for the preoperative differentiation of GBM from solitary brain MET, which could aid pretreatment decision-making. [ABSTRACT FROM AUTHOR]

Background: Circumferential resection margin (CRM) status is an important predictor of outcomes after rectal cancer operation, and is influenced not only by operative technique, but also by incorporation of a multidisciplinary treatment strategy. This study sought to develop a risk-adjusted quality metric based on CRM status to assess hospital-level performance for rectal cancer operation.Study Design: We conducted a retrospective observational cohort study of 58,374 patients with resected stage I to III rectal cancer within 1,303 hospitals who were identified from the National Cancer Database (2010 to 2015). The number of observed cases with a positive CRM (≤ 1 mm) was divided by the risk-adjusted expected number of cases with positive CRM to form the observed-to-expected (O/E) ratio. Secondary endpoint was overall survival.Results: The overall rate of CRM positivity was 15.9%. Based on the O/E ratio for 1,139 hospitals, 147 (12.9%) and 103 (9.0%) were significantly worse and better performers, respectively. The majority of hospitals (n = 570) performed as expected. Positive CRMs using criteria of 0 mm and 0.1 to 1 mm were associated with a significantly shorter 5-year overall survival of 49% and 63.5% (hazard ratio 1.67; 95% CI, 1.57 to 1.76 and hazard ratio 1.19; 95% CI, 1.12 to 1.26) than negative CRM > 1 mm of 74.1% (all p < 0.001).Conclusions: CRM-based O/E ratio is a robust hospital-based quality measure for rectal cancer operation. It allows facilities to compare their performance with that of centers of similar characteristics and helps identify underperforming, at-risk, and high-performing centers. National quality-improvement initiatives for rectal cancer should focus on ensuring high-quality data collection and providing ready access to risk-adjusted comparative metrics. [ABSTRACT FROM AUTHOR]