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ZnO nanorod arrays (NRAs) were fabricated on polyester fabrics (PFs) by a two-step method and modified with Ag by magnetron sputtering. The photogenerated charge transport properties of the Ag/ZnO nanorod heterojunctions were studied by a self-made Kelvin probe system and a surface photovoltage (SPV) test system. The measured work functions (WFs) of the deposited Ag and ZnO nanorod are 4.67 and 5.56 eV, respectively. The SPV spectra indicate that the direction of the inner electric field is from the Ag layer to the inner of the ZnO nanorod. The enhancement of light absorption by the local surface plasma resonance (LSPR) effect of Ag/ZnO NRA was observed by Raman microspectroscopy and UV–vis diffuse reflectance spectroscopy. The photocatalytic activity of the Ag/ZnO NRA-functionalized PFs was evaluated by the photocatalytic degradation of Rhodamine B (RB) solution under visible light. The full photo-oxidation of RB and the outperforming ZnO NRA-coated PFs demonstrate that the enhanced photocatalytic performance of Ag/ZnO NRA-coated PFs results from the cooperation of the inner electric field of the Ag/ZnO nanorod heterojunction and Ag LSPR.

Micro-supercapacitors with high power density and stability promise emerging energy storage devices. However, their relatively low energy density and poor mechanical stability largely restricts their application. Here, we report an all-in-one planar micro-supercapacitor (MSC) using ZnO nanosheets anchored on the porous and 3D laser-induced porous graphene foams (ZnO@LIG) as the electrode materials. Due to the 3D networks, the hybrid electrode exhibits fast charge transfer and diffusion channels. More importantly, the hybrid approach can simultaneously take advantage of double-layer capacitance and faradaic energy storage mechanisms. The ZnO@LIG electrode displays a high specific capacitance of 14.7 F cm−2, remarkable rate capability and cycling stability. Furthermore, the MSC showcases high energy density (10.0 Wh kg−1), high power density (0.5 Wh kg−1), long-term stability, and excellent mechanical stability upon bending. The excellent performance parameters of the MSC make it one of the promising micropower sources for flexible microelectronics.

Targeting glutamine catabolism has been attracting more research attention on the development of successful cancer therapy. Catalytic enzymes such as glutaminase (GLS) in glutaminolysis, a series of biochemical reactions by which glutamine is converted to glutamate and then alpha-ketoglutarate, an intermediate of the tricarboxylic acid (TCA) cycle, can be targeted by small molecule inhibitors, some of which are undergoing early phase clinical trials and exhibiting promising safety profiles. However, resistance to glutaminolysis targeting treatments has been observed, necessitating the development of treatments to combat this resistance. One option is to use synergy drug combinations, which improve tumor chemotherapy's effectiveness and diminish drug resistance and side effects. This review will focus on studies involving the glutaminolysis pathway and diverse combination therapies with therapeutic implications.

In this letter, a fully transparent AlGaN/GaN HEMT (FT-HEMT) using indium-tin-oxide (ITO) as a transparent electrode is fabricated. The n-ohmic contacts are formed based on a Si-implant process using a deposited ITO rather than the conventional alloyed metal stacks. Following a post-annealing process at 600°C, the field-effect mobility and the maximum current density for an FT-HEMT were 1004 cm2/ $\text{V}{\cdot }\text{s}$ and 179 mA/mm, respectively. Furthermore, the measured transmittance for a fabricated chip in the visible range of 400 - 700 nm was greater than 70%, which is almost the same as an as-grown GaN-on-sapphire substrate. These results show that, by using this approach, an FT-HEMT that has superior electronic properties, such as high mobility and high output current, can be realized, and show great promise for applications in transparent and/or flexible electronics, as well as other optoelectronic devices.

Understanding the biological and clinical impact of copy number aberrations (CNA) in cancer remains an unmet challenge. Genetic amplification of chromosome 1q (chr1q-amp) is a major CNA conferring adverse prognosis in several cancers, including the blood cancer, multiple myeloma (MM). Although several chr1q genes portend high-risk MM disease, the underpinning molecular aetiology remains elusive. Here we integrate patient multi-omics datasets with genetic variables to identify 103 adverse prognosis genes in chr1q-amp MM. Amongst these, the transcription factor PBX1 is ectopically expressed by genetic amplification and epigenetic activation of its own preserved 3D regulatory domain. By binding to reprogrammed super-enhancers, PBX1 directly regulates critical oncogenic pathways, whilst in co-operation with FOXM1, activates a proliferative gene signature which predicts adverse prognosis across multiple cancers. Notably, pharmacological disruption of the PBX1-FOXM1 axis, including with a novel PBX1 inhibitor is selectively toxic against chr1q-amp cancer cells. Overall, our systems medicine approach successfully identifies CNA-driven oncogenic circuitries, links them to clinical phenotypes and proposes novel CNA-targeted therapy strategies in cancer.SignificanceWe provide a comprehensive systems medicine strategy to unveil oncogenic circuitries and inform novel precision therapy decisions against CNA in cancer. This first clinical multi-omic analysis of chr1q-amp in MM identifies a central PBX1-FOXM1 regulatory axis driving high-risk prognosis, as a novel therapeutic target against chr1q-amp in cancer.

Purpose: Studies involving mouse models and human uterine smooth muscle cells have shown that phenylephrine inhibits uterine contractions in non-pregnant mice and human in vitro cell via cyclic adenosine monophosphate (cAMP) signaling. However, there has been no limited exploration to date of the effect of phenylephrine on uterine contractions in clinical practice. This study aimed to compare the dose requirement of oxytocin with or without the infusion of prophylactic phenylephrine to prevent post spinal hypotension during cesarean delivery under combined spinal and epidural anesthesia.Methods: This was a double-blinded, single-center, randomized, control study. One hundred and sixty pregnant patients provided informed consent and were randomly allocated to the phenylephrine (phenylephrine infusion) and control (saline infusion) groups. Patients randomized to the phenylephrine group received an intravenous prophylactic phenylephrine infusion at a fixed rate of 0.5 μg/kg/min. The control group received a saline placebo at the same rate and used the same apparatus for delivery. After neonatal delivery and clamping of the umbilical cord, patients received a standard institutional oxytocin protocol. The primary outcome measure was the total dose of oxytocin administered during CD. Secondary outcomes including the proportion (%) of patients requiring a secondary uterotonic agent and estimated blood loss (EBL) in the first 24 h after surgery.Results: The median oxytocin dose administered was significantly higher in the phenylephrine group than in the control group [6.9 ± 2.5 international standardized units (IU) vs. 5.4 ± 2.4 IU, p = 0.0004]. The number of patients that required a secondary uterotonic agent was significantly higher in the phenylephrine group than in the control group (24.2% vs. 9.1%; p = 0.034). The EBL in the first 24-h postoperatively was similar between the two groups (467 ± 47 ml vs. 392 ± 38 ml; p = 0.22).Conclusions: Prophylactic infusion of phenylephrine used to prevent post-spinal hypotension during CD was associated with a higher dose of oxytocin. This has important clinical implications, as the suboptimal use of oxytocin is associated with an increased risk of postpartum hemorrhage and increased maternal morbidity and mortality. Further studies are now needed to confirm these findings.

In recent years, monolithic integration of HEMT and LED was attempted to improve overall switching speed, reliability, and efficiency [1] . Typically, HEMT-LED monolithic integration can be realized via selective-epi-removal [2] or selective-area-growth [3] . Different from previous approaches that have adopted the lateral integration of HEMTs and LEDs, we have recently demonstrated an AlGaN/GaN HEMT that includes a built-in light emitter called a light-emitting HEMT (LE-HEMT) which uses a simple and cost-effective process [4] . In order to further improve the light intensity and efficiency, a single quantum well (QW) epi consisting of 10-nm u-GaN/3-nm InGaN inserted into a standard (STD) p-GaN/AlGaN/GaN HEMT epi structure was designed in this study. The electrical and optical characteristics were evaluated.

Global warming along with energy demand and rising prices of natural energy resources have motivated studies to find some renewable and clean energy. The use of algae as the third-generation biofue...

Increasing information supported that achieving high-rate mainstream deammonification through two-stage partial nitritation (PN)-anammox process should be a better option than through single-stage process. However, direct experimental evidence was limited so far. Herein, a two-stage PN-anammox process was successfully operated for nitrogen removal from low-strength wastewater in winter. Influent shift from synthetic wastewater to actual anaerobically pretreated sewage had little impact on the process performance. Promising nitrogen removal rates (NRRs) of 0.28–0.07 kg N m−3 d−1 with an average effluent concentration of 5.2 mg TN L−1 were achieved for the anaerobically pretreated sewage treatment at 15–7 °C. Moreover, nearly all the degradable COD in the pretreated sewage was steadily removed in the first-stage PN reactor, despite the varied influent COD concentrations of 22–78 mg L−1 and the operating temperature decrease, suggesting the positive role of the first-stage PN in protecting anammox bacteria. The low temperature seemingly was the only deterministic factor inhibiting the anammox activity, and hence made the anammox reaction to be the rate-limiting step for nitrogen removal in the two-stage PN-anammox process. Unexpectedly, nearly all the anammox bacteria remained active at low temperatures with the process actual anammox activity reached about 76–85% of their maximum potential, implying that higher NRRs would be easily realized through bioaugmentation or enrichment of anammox bacteria. Overall, the present investigation provides direct and valuable information for implementing the two-stage PN-anammox process to treat mainstream municipal wastewater. A control strategy was also proposed to optimize the operation of the two-stage mainstream deammonification process.

High sulfide inhibited the activities of sulfate-reducing bacteria (SRB) and methane-producing bacteria (MPB). In addition, a large number of domestic sewages should be treated in China. Thus, it is the first time that domestic sewage was collected to dilute high-sulfate wastewater in this study to achieve simultaneous treatment of sulfate wastewater and domestic sewage in the anaerobic baffled reactor (ABR). The results showed that there were obvious separation of sulfate reduction phase and methane production phase in the ABR, and large sulfate were reduced in the front compartments. Micro-aeration (oxygen demand of 0.4-0.6 mg/L) could significantly decrease sulfide concentration from 45 mg/L to 5 mg/L. Furthermore, micro-aeration between sulfate-reducing and methane-producing phases could significantly promote the synergistic removal of organics by SRB and MPB, while COD removal efficiency increased from 80% to 95%, and sulfate removal efficiency increased from 80% to 90%. And the highest elemental sulfur recovery rate was 0.27 kg/(m3.d). Finally, the ABR that operated with C/S of 2, HRT of 12 h and COD load of 4 kg/ (m3.d), micro-aeration (DO of 0.4-0.6 mg/L) at the end of sulfate reduction phase (the compartment 5) has proved to be efficient in simultaneous sulfate wastewater and domestic sewage treatment and is suitable for elemental sulfur recovery.

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Background The prevalence of undiagnosed mild cognitive impairment (MCI) in elderly patients scheduled for thoracic surgery and its association with adverse clinical outcomes is still unproven. Methods We enrolled 170 patients 65 year of age or older who were scheduled for thoracic surgery. 82 males and 88 females with ASA grade II-III. All the elderly patients were tested with Chinese modified version of MoCA preoperatively. According to the test results, they were divided into two groups: group N (MoCA score>25) and group AN (MoCA score≤25). Outcomes included the hospital length of stay (primary outcome), the length of stay in patients with PPCs (LOS-PPCs), the pulmonary complications (atelectasis, pulmonary infection, respiratory failure) and other complications (blood transfusion, chylothorax, new arrhythmia, myocardial infarction and acute cerebral infarction) (secondary outcomes). Data were analyzed using univariate and multivariate analyses. Results Seventy-four of 154 (49%) patients screened positive for probable mild cognitive impairment (MoCA ≤ 25) in the final analyses. The hospital length of stay and LOS-PPCs in elderly patients with mild cognitive impairment preoperatively were significantly longer than those with group N (P

It is known that quartz crystal blanks have to go through many procedures of mechanical processing for the exact configuration to ensure precise geometry for expected performance. Some procedures involving mechanical processing are widely used for the shaping and reduction in sizes could be done with laser beams to satisfy the objectives. Given the fact laser beams can be speedy and cleaner in the process, it is imaginable that some mechanical processing procedures can be replaced by laser radiation or other energy methods at a lower cost. To this goal, we use laser with different strengths and durations to scan the selected surface areas of blanks of quartz crystal to change the property of exposed portions with noticeable changes. After validation of the laser processing, we started scanning quartz crystal blanks of resonators for improvements. The experiments showed that with properly designed radiation pattern and areas, we should be able to use the laser treatment as part of the manufacturing process to innovate the existing process and products.

Background Spleen tyrosine kinase (SYK) is frequently upregulated in recurrent ovarian carcinomas, for which effective therapy is urgently needed. SYK phosphorylates several substrates, but their translational implications remain unclear. Here, we show that SYK interacts with EGFR and ERBB2, and directly enhances their phosphorylation. Methods We used immunohistochemistry and immunoblotting to assess SYK and EGFR phosphorylation in ovarian serous carcinomas. Association with survival was determined by Kaplan-Meier analysis and the log-rank test. To study its role in EGFR signaling, SYK activity was modulated using a small molecule inhibitor, a syngeneic knockout, and an active kinase inducible system. We applied RNA-seq and phosphoproteomic mass spectrometry to investigate the SYK-regulated EGF-induced transcriptome and downstream substrates. Findings Induced expression of constitutively active SYK130E reduced cellular response to EGFR/ERBB2 inhibitor, lapatinib. Expression of EGFRWT, but not SYK non-phosphorylatable EGFR3F mutant, resulted in paclitaxel resistance, a phenotype characteristic to SYK active ovarian cancers. In tumor xenografts, SYK inhibitor reduces phosphorylation of EGFR substrates. Compared to SYKWT cells, SYKKO cells have an attenuated EGFR/ERBB2-transcriptional activity and responsiveness to EGF-induced transcription. In ovarian cancer tissues, pSYK (Y525/526) levels showed a positive correlation with pEGFR (Y1187). Intense immunoreactivity of pSYK (Y525/526) correlated with poor overall survival in ovarian cancer patients. Interpretation These findings indicate that SYK activity positively modulates the EGFR pathway, providing a biological foundation for co-targeting SYK and EGFR. Fund Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, NIH/NCI, Ovarian Cancer Research Foundation Alliance, HERA Women's Cancer Foundation and Roseman Foundation. Funders had no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript and eventually in the decision to submit the manuscript.

Quartz crystal resonators are important frequency control elements in electronic products with a complicated manufacturing process. During operations of a resonator, the coupling between the main functioning mode and the spurious modes should be avoided, since it will greatly increase the resistance and reduce the quality factor value, making it unable to work steadily and efficiently. In order to limit the spurious modes and reduce the mode couplings, an experimental study was conducted on the processing of quartz crystals by picosecond lasers. And we have investigated the effects of parameters of picosecond laser irradiation on properties of quartz crystal blanks. We irradiated both ends of quartz crystal blanks with a picosecond laser beam, and the laser power was controlled to limit the total input. Then we manufactured quartz crystal resonators with the laser processed blanks and measured their properties. After the quartz crystal blanks are irradiated with different power levels, the performance of the quartz crystal resonator does have some changes. Our goal is to explore the effects of laser irradiation on quartz crystals and optimize quartz crystal resonators with the selection of irradiation areas and power levels. With the noticeable effects from the first batch of test samples, we are studying novel irradiation schemes for more samples and measurements.

In view of the influence of tuyere layout change on velocity field in oxy-coal combustor-melter-separator furnace, three-dimensional numerical simulation method was used to compare the distribution of velocity field in the furnace under different tuyere layout. The purpose is to explore the influence of the velocity distribution on the molten pool flow in the process of multi-tuyere injection. It is shown that the maximum velocity of the upper and lower tuyeres is 60 m/s and 50 m/s. And the change of tuyere has a significant effect on the velocity distribution in the molten pool, and the sudden change of velocity near the tuyere will trigger a certain scale of gyratory zone. In addition, the change of tuyere arrangement will result in the concentration of velocity distribution in the molten pool and the increase of flow dead zone, while the change of tuyere spacing will not only promote the increase of flow dead zone, but also reduce the velocity distribution area.

Cell surface proteins such as CD44 and CD24 are used to distinguish cancer stem cells (CSCs) from the bulk-tumor population. However, the molecular functionalities of CD24 and CD44, and how these two molecules coordinate in CSCs remain poorly understood. We found that nasopharyngeal carcinoma (NPC) cells with high expression of CD44 and CD24 proteins presented with pronounced CSC properties. Accordingly, a subpopulation of NPC cells with co-expression of CD44 and CD24 were specially enriched in high-stage clinical samples. Furthermore, ectopically expressing the epithelial-mesenchymal transition (EMT) regulator Twist was able to upregulate the stemness factors, and vice versa. This indicates a reciprocal regulation of stemness and EMT. Intriguingly, we found that this reciprocal regulation was differentially orchestrated by CD44 and CD24, and only simultaneous silencing the expression of CD44 and CD24 led to a broad-spectrum suppression of CSC properties. Oppositely, overexpression of CD44 and CD24 induced the reprogramming of parental NPC cells into CSCs through STAT3 activation, which could be blunted by STAT3 inhibition, indicating that CD44 and CD24 collaboratively drive the reprogramming of NPC cells through STAT3-mediated stemness and EMT activation. Consequently, targeting of the CD44/CD24/STAT3 axis may provide a potential therapeutic paradigm for the treatment of NPC through repressing CSC activities.

The effects of influent shift from synthetic wastewater to anaerobically pretreated actual sewage coupling with lowering temperature on microbial community of a two-stage partial nitritation (PN)-anammox process were evaluated through high-throughput sequencing. Venn diagrams and Hill numbers showed the significantly increased bacterial diversity both in the PN and anammox reactor. However, taxonomic analysis indicated that outstanding enrichment of heterotrophic bacteria and reduction of autotrophic species mainly occurred in the PN reactor, while nearly all of the dominant bacteria in the anammox reactor only slightly decreased in abundance. Moreover, immigrant bacteria from the PN reactor to the following anammox reactor had no negative effect on the anammox function. These results implied the positive role of the first-stage PN in maintaining the stability of the following anammox community. Nitrosomonas europaea (17.9–52.9%) and one cluster (19.2–27.7%) within Candidatus Brocadia remained as the dominant functional species in the PN and anammox reactor, respectively.

Objective Wallerian degeneration (WD) of middle cerebellar peduncles (MCPs) secondary to pontine infarction is rarely reported in the literature. Our aim in this study is to characterize its clinical and neuroradiological features. Methods A retrospective review of 7 patients from a single institution was conducted. Only patients with pontine infarction and subsequent degeneration of the MCPs were included in the analysis. The features of clinical presentation and neuroimaging finding were summarized by our experienced neurologists. Results Seven patients (5 male, 2 female), ranging in age from 50 to 77 years, satisfied the inclusion criteria. All patients had cardiovascular risk factors and hypertension was the most common one. Almost all of the patients had hemiparesis and dysarthria, and could achieved good clinical outcome. On the initial scan, hyperintense on T2- and diffusion-weighted images suggested the acute pontine infarction. On the follow-up scan, however, hyperintensities of bilateral MCPs on T2-weight and FLAIR images were apparently demonstrated in all patients. The specific lesions in the MCPs were attributed to bilateral WD of the pontocerebellar fibres secondary to pontine infarction. Conclusion WD should be taken into account when patients are initially diagnosed with paramedian pontine infarction and follow-up MRI manifest as symmetrical hyperintense in the MCPs.

Objective: To explore the feasibility and clinical value to keep the denatured dermis in the deep II degree burns. Methods: With the consent of the 41 patients, their burn wounds were divided into two groups, one group is called the observation group, and the other is called the control group. Comparison was made in the same body. Apply retaining denatured dermis plus autograft skin in the observation group and scab removing plus autograft skin in the control group, individually. Then compare the following factors of the two groups: blood loss amount, 14th day wound healing rate, and the color B-measurement of the thickness from the skin surface to fascia thickness. Results: The blood loss was 10.2 ± 2.3 ml in the observation group, 39.2 ± 6.1 ml in the control group. t = - 22.3, P = 0.000; 14d wound healing rate was 75.6% (31/41) in the observation group, and 87.8% (36/41) in the control group. 2= 0.581; P > 0.05. The thickness of skin and subcutaneous tissue was measured to be 1.2 ± 0.5cm in the observation group, and 0.8 ± 0.3cm in the control group, t = 19.4, P = 0.000. Conclusions Retain denatured dermis and implant autograft skin surgery can reduce the intensity of operation, it can also benefit the skin and soft tissue reconstruction. Thus, it is one of the most effective surgical methods in the treatment of deep II degree burns.

Yao An Shen,1,* Ing Luen Shyu,2,* Maggie Lu,3 Chun Lin He,4 Yen Mei Hsu,2 Hsiang Fa Liang,3 Chih Peng Liu,3 Ren Shyan Liu,5,6 Biing Jiun Shen,7 Yau Huei Wei,1 Chi Mu Chuang2,4 1Institute of Biochemistry and Molecular Biology, School of Life Sciences, 2Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, 3Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu, 4Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, 5Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, 6National PET/Cyclotron Center, Taipei Veterans General Hospital, Taipei, Taiwan; 7Division ofPsychology, Nanyang Technological University, Singapore *These authors contributed equally tothe work Abstract: The current enhanced permeability and retention (EPR)-based approved nanomedicines have had little impact in terms of prolongation of overall survival in patients with cancer. For example, the two Phase III trials comparing Doxil®, the first nanomedicine approved by the US Food and Drug Administration, with free doxorubicin did not find an actual translation of the EPR effect into a statistically significant increase in overall survival but did show less cardiotoxicity. In the current work, we used a two-factor factorial experimental design with intraperitoneal versus intravenous delivery and nanomedicine versus free drug as factors to test our hypothesis that regional (intraperitoneal) delivery of nanomedicine may better increase survival when compared with systemic delivery. In this study, we demonstrate that bypassing, rather than exploiting, the EPR effect via intraperitoneal delivery of nanomedicine harboring a sustained-release function demonstrates dual pharmacokinetic advantages, producing more efficient tumor control and suppressing the expression of stemness markers, epithelial-mesenchymal transition, angiogenesis signals, and multidrug resistance in the tumor microenvironment. Metastases to vital organs (eg, lung, liver, and lymphatic system) are also better controlled by intraperitoneal delivery of nanomedicine than by standard systemic delivery of the corresponding free drug. Moreover, the intraperitoneal delivery of nanomedicine has the potential to replace hyperthermic intraperitoneal chemotherapy because it shows equal efficacy and lower toxicity. In terms of efficacy, exploiting the EPR effect may not be the best approach for developing a nanomedicine. Because intraperitoneal chemotherapy is a type of regional chemotherapy, the pharmaceutical industry might consider the regional delivery of nanomedicine as a valid alternative pathway to develop their nanomedicine(s) with the goal of better tumor control in the future. Keywords: enhanced permeability and retention effect, liposome, paclitaxel, ovarian cancer&nbsp

Background and purpose Cancer stem cells exhibit distinctive cellular metabolism compared with the more differentiated counterparts or normal cells. We aimed to investigate the impact of a novel radionuclide anti-cancer agent 188 Re-Liposome on stemness markers' expression and cellular metabolism in an ovarian cancer model. Material and methods A 2×2 factorial experiment was designed in which factor 1 represented the drug treatment comparing 188 Re-BMEDA, a free form of 188 Re, with 188 Re-Liposome, a nanoparticle-encapsulated form of 188 Re. Factor 2 represented the delivery route, comparing intravenous with intraperitoneal delivery. Results Intraperitoneal delivery of 188 Re-Liposome predominantly killed the CSCs-like cells in tumours and switched metabolism from glycolysis to oxidative phosphorylation. Further, intraperitoneal delivery of 188 Re-Liposome treatment was able to block epithelial-to-mesenchymal transition (EMT) and reactivate p53 function. Collectively, these molecular changes led to a striking tumour-killing effect. Conclusions Radionuclides encapsulated in liposomes may represent a novel treatment for ovarian cancer when delivered intraperitoneally (a type of loco-regional delivery). In the future, this concept may be further extended for the treatment of several relevant cancers that have been proved to be suitable for loco-regional delivery of therapeutic agents, such as colon cancer, gastric cancer, and pancreatic cancer.

To the Editor: Letrozole, a third-generation aromatase inhibitor (AI), is a relatively newer class of endocrine agents used in hormone-receptor-positive breast cancer.[1] Vascular thrombotic events, such as acute myocardial infarction and acute cerebral infarction, in patients with breast cancer after initiation of letrozole therapy have been documented in the literature.[2,3] However, the impact of this adjuvant endocrine therapy on increasing the risk of developing vascular thrombotic events has been a controversial issue. Here, we report a rare case of a woman with breast cancer developing unilateral internal carotid artery (ICA) occlusion after letrozole treatment. On October 9, 2015, a 56-year-old postmenopausal woman with 2 years history of hypertension was admitted to the Second Affiliated Hospital of Nanchang University with dizziness for 4 days. She had suffered once transient numbness of the right limbs 1 week previously. Except for diagnosed with breast cancer (infiltrative ductal carcinoma) 2 years ago, her previous medial history was unremarkable. She had been treated with modified radical mastectomy, adjuvant radiotherapy, and chemotherapy (5-fluorouracil, doxorubicin, and cyclophosphamide). No evidence of breast cancer recurrence had been verified by follow-up imagings with computerized tomography (CT) and mammography during 1 year follow-up. One year before admission, brain magnetic resonance (MR) angiography (Figure 1a) and Doppler ultrasonography examination did not reveal any severe stenosis or occlusion of cerebral arteries. At the same time, lipid profiles and estrogen levels showed total cholesterol (6.16 mmol/L), triglycerides (1.56 mmol/L), low density lipoprotein (3.94 mmol/L) and estradiol (43.2 pmol/L). Subsequently, an AI of letrozole 25 mg/d was initiated until admission. On admission, right superficial temporal artery pulse could be touched obviously. The rest of neurological examination was normal. On day 2 after admission, brain MR imaging on admission showed normal signal intensity. However, MR angiography revealed homolateral occlusion of ICA and middle cerebral artery [Figure 1b]. CT angiography showed occlusion of the entire right ICA as well as the patency of anterior communicating artery [Figure 1c]. Meanwhile, Doppler ultrasonography examination detects no blood flow signals of right ICA. In addition, multifocal atherosclerotic plaques formation could be found in common carotid arteries, external carotid arteries, and subclavian arteries bilaterally. Electrocardiogram showed a normal sinus rhythm. Laboratory studies revealed increased total cholesterol (6.93 mmol/L), triglycerides (3.36 mmol/L), and low-density lipoprotein (3.44 mmol/L) after hospitalization. Letrozole was stopped on day 3 and our patient was administrated with aspirin (100 mg/d) and atorvastatin (20 mg/d). After her dizziness symptom was improved moderately, she was discharged on day 10. Figure 1 (a) Brain magnetic resonance angiography 1 year before admission did not reveal any severe stenosis or occlusion of right internal carotid artery; (b) brain magnetic resonance angiography on admission showed complete occlusion of right internal carotid ... Third-generation AIs, as their superior efficacy and lower risk of recurrent disease compared to tamoxifen, have become important agents for postmenopausal women with hormone-receptor-positive breast cancer. AIs inhibit the activity of estrogen by competitively binding to the estrogen receptor, thereby blocking the conversion of androgens to estrogens, which may finally result in estrogen levels decreasing in tissue and plasma. Moreover, the decreased estrogen levels play a key role in inhibiting the growth of breast tumors.[4] However, the Breast International Group 1-98 study shows that AIs therapy can also be accompanied by adverse events, such as thromboembolic events, cardiac events, and cerebrovascular accidents accounting for nearly 1%.[1] At present, whether AIs treatment can increase risk of cerebrovascular or cardiovascular accidents in patients with breast cancer is not clear in the literature. Although several cerebrovascular risk factors including postmenopausal state, hyperlipidemia, and hypertension are found in this patient, 1-year adjuvant letrozole therapy was to some extent blamed for changing of the right ICA from normal blood flow to total occlusion in short time. Comparing the variation of lipid profiles and estrogen levels between pre- and post-letrozole administration in plasma, it indicates that letrozole may increase the production of lipid profiles (especially triglycerides). In addition, Doppler ultrasonography examination demonstrates increased quantity and size of atherosclerotic plaques in cerebral arteries. We, therefore, speculate that letrozole may play an important role in aggravating atherosclerosis formation by regulating lipid profiles. Combining with above cerebrovascular risk factors, letrozole makes for unilateral ICA occlusion within such a short time. Previous studies investigating the effects of different AIs on lipid profiles have demonstrated mixed results. Because of the intricate biological relationship of estrogen with lipid profiles and metabolism, the mixed results from previous studies may be explained by heterogeneity in genes involved in estrogen signaling and estrogen and AI metabolism.[5] However, our study was limited to a case report. We expect more, larger sample clinical studies will be devoted to exploring the correlation between letrozole therapy and cerebrovascular adverse events. Efforts should be made, if possible, to avoid the occurrence of adverse event in patients with breast cancer after initiation of letrozole therapy, such as controlling risk factors actively and oral administration with aspirin and statin agents routinely. In conclusion, letrozole therapy causing ICA occlusion is extremely rare. It may increase the production of lipid profiles, and then play an important role in aggravating atherosclerosis formation. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Environment is vital medium for the ecosystems to be sustained, however human beings have put pressure on it, due to recent rise in populations and rapid industrialization. These have led to uncontrolled anthropogenic activities, which interferes with natural ecosystems and affects sustainability of development. For this reason, Ethiopia and Kenya decided to adopt and implement the Environmental impact assessment (EIA) tool, so as to make sure the environment is protected and sustained. This paper focuses on the common challenges in both East African nations in order to increase accountability and transparency during implementation of any project. It also comprises EIA guidelines comparison based on principles and procedure of EIA and indicates possible way out in which EIA might be used more productively in the future.

Urbanization is on the rise in Africa and this trend is expected to continue in the future. Of concern is that the infrastructure and land use planning including for waste management is not coping with the growth of urban areas (around 3.5% annually, highest in the world). This is particularly urgent in the slum areas which constitute a big part of many of the cities and towns in Africa. Environmental sanitation and waste management is aimed at developing and maintaining a clean, safe, and pleasant physical and natural environment in all human settlements, to promote the socio-cultural, economic and physical well-being of all sections of the population. Waste management comprises a number of complimentary activities, the provision and maintenance of sanitary facilities, the provision of services, public education, regulation and legislation supported by clearly mandated institutions, adequate funding, research and development. This paper seeks to focus the challenges and prospects of solid waste management and the legal or policy arrangements available to ensure environmental sustainability.

Currently, epithelial ovarian cancer is viewed as a heterogeneous disease with five major histological subtypes. Clear cell carcinoma represents a specific histological subtype of epithelial ovarian cancer that demonstrates more aggressive clinical behavior and drug resistance compared with other subtypes. Nevertheless, clear cell carcinoma is treated in the same manner as the other subtypes without any particular consideration to its unique clinical characteristics. To improve the therapeutic efficacy of the current liposomal doxorubicin approach for the treatment of clear cell carcinoma, we aimed to develop a novel peptide-conjugated liposomal doxorubicin to actively target this subtype. Two phage clones (OC-6 and OC-26) that specifically bound to clear cell carcinoma were isolated from a phage peptide display library after biopanning procedures. The peptide sequences were translated and aligned (OCSP-6 for OC-6, and OCSP-26 for OC-26, respectively). Peptide-conjugated nanoparticles demonstrated better tumor endocytosis and time-dependent gradual increase of intracellular drug uptake than non-targeting liposomal nanoparticles. Furthermore, peptide-conjugated liposomal doxorubicin better controlled tumors than did non-targeting liposomal doxorubicin. The current work may pave a new way for the development of drugs that target each subtype of epithelial ovarian cancer in the future.

Oral cancer overexpressed 1 (ORAOV1) has been reported to exhibit high amplification levels in esophageal squamous cell cancer (ESCC) and in premalignant lesions. However, ORAOV1 protein expression levels in ESCC and esophageal squamous intraepithelial neoplasia (ESIN) have not yet been reported. We have explored the relationship of ORAOV1 protein expression with ESCC and ESIN by immunohistochemically analyzing tissue microarrays containing esophageal samples from patients with various clinical features and prognoses. The percentage of ESCC, high-grade ESIN (HGESIN), low-grade ESIN (LGESIN), and nontumoral control patients overexpressing ORAOV1 were 70.63% (101/143), 77.36% (41/53), 48.96% (47/96), and 5.79% (7/121), respectively. ORAOV1 overexpression also appears to be significantly higher in ESCC, HGESIN, and LGESIN than in the controls (all P < .001), and the levels observed for ESCC and HGESIN were also significantly higher than that in LGESIN (both P = .001). These results corresponded to high sensitivity and specificity values in ESCC, HGESIN, and LGESIN tissues. Furthermore, the increased expression of ORAOV1 is significantly associated with lymph node metastasis (P = .001) and an advanced TNM stage (III + IV) (P = .014), and patients with ORAOV1 overexpression experienced shorter overall survival time compared with those with lower ORAOV1 (χ(2) = 11.505, P = .001). This study provides the first evidence of ORAOV1 overexpression in ESCC and ESIN and demonstrates a potential role in tumor progression and metastasis. ORAOV1 overexpression could, therefore, be used as a novel biomarker of poor prognosis in patients with ESCC.

To the Editor: Varicella-zoster virus (VZV) infection can lead to zoster or cranial nerve palsy such as Ramsay Hunt syndrome (RHS), or complications of central nervous system (CNS) such as myelitis, cerebellitis, encephalitis, and stroke syndrome.[1,2] However, the coexistence of RHS and VZV brainstem encephalitis is extremely rare to our knowledge. We, therefore, report a patient who presented with RHS and multiply cranial nerve palsies. A 58-year-old immunocompetent man felt febrile and severe otalgia with a frequent dry cough. One week later, he gradually developed left facial paralysis, left ear hearing loss, and vertigo. After another 3 days, dysarthria, swallowing difficulty, and intractable hiccup presented sequentially. On the next day, he complained of diplopia with extraocular movement limitation and was admitted to the Second Affiliated Hospital of Nanchang University. On admission, his vital signs were stable. Neurological examinations showed the following: Left eye immobilization with right eye adduction limitation, left facial weakness and hypesthesia, left sensorineural hearing loss, paralysis of the left soft palate, and slurred speech. There were slightly decreased muscle power and hyperreactive tendon reflexes with a positive Barbinski sign contralaterally. Coordinate movement of four limbs was impaired, and the Romberg test was positive. Carefully, herpetic vesicles, erythematous ulcerative, and crusted scars were observed around the left external acoustic meatus. Brain magnetic resonance imaging (MRI), on admission [Figure 1], revealed a high signal intensity lesion involving basis pontis and medulla oblongata on both the T2-weighted image [Figure 1b] and fluid attenuation inversion recovery (FLAIR) [Figure 1d]. Magnetic resonance angiography showed normal findings. Moreover, contrast-enhanced MRI showed a spot-like enhancement in medulla oblongata as well as enhanced left facial nerve [Figure ​[Figure1e1e and ​and1f].1f]. On day 2 after admission, an electroencephalogram showed diffuse theta waves. Meanwhile, the cerebrospinal fluid (CSF) analysis showed an increased cell count (1360/mm3, 80% lymphocytes) and protein level (1.37 g/L). CSF cultures for bacteria, fungus, tuberculosis, and herpes simplex virus DNA were negative. This patient was immediately administrated with intravenous acyclovir (10 mg/kg every 8 h) and methylprednisolone (40 mg/d) after hospitalization. Three days after admission the patient deteriorated with paralysis of bilateral limbs and pulmonary inflammation. He was treated with empiric antibiotics. On day 7, an elevated serum IgM antibody titer to VZV on enzyme-linked immunosorbent assay (ELISA) and the presence of CSF VZV DNA amplified by polymerase chain reaction (PCR) confirmed VZV infection. On day 14, his vertigo, swallowing and speaking function improved moderately, but his hearing loss and facial palsy remained unaltered. One month later, follow-up brain MRI demonstrated that the extent of the lesion had decreased [Figure ​[Figure1g1g–1I] and PCR for VZV DNA in CSF became negative. Clinically, he could walk alone and hear high tone voice in his left ear. Figure 1 On admission, brain magnetic resonance imaging (MRI) shows the lesion in the basis pontis and medulla oblongata: T1-weighted hypointense (a), T2-weighted (b) and fluid attenuation inversion recovery (FLAIR) hyperintense (d), and slightly diffusion-weighted ... VZV is a member of the family Herpesviridae with the ability to establish latency in dorsal root-, autonomic- and cranial ganglia. After reactivation, VZV causes herpes zoster in most cases. VZV might also infect CNS causing various neurological manifestations.[3,4] With the introduction of using PCR for detection of virus DNA in CSF, VZV has been reported to be the second most common viruses of encephalitis recently.[5] Based on herpes zoster with facial nerve palsy, our patient fulfills the criteria for RHS. Moreover, he can also be diagnosed with VZV brainstem encephalitis according to CSF evidence of VZV and pontobulbar involvement on brain MRI. However, reports about RHS accompanied by VZV encephalitis have been rarely documented in the literature. The reason for the low incidence of RHS complicated by VZV encephalitis is not well understood. Clinically, our case was initially diagnosed with RHS. Subsequently, he presented with multiple cranial nerve palsies (from III to X cranial nerves) and central spastic palsy (bilateral pyramidal tracts involvement), which may suggest a brainstem insult. Furthermore, transverse hyperintensities in central pons on T2-FLAIR obviously showed the lesions. Meanwhile, contrast-enhanced MRI showed enhanced left facial nerve. We speculate the possible mechanism of VZV spreading to CNS is the reactivated viruses, which establish latency in geniculate ganglia, upward thread porus acusticus internus along with facial canal, and eventually enter intracranially and firstly invade basis pontis. Meanwhile, VZV may also spread downwards along with general somatosensory fibers to the skin of external auditory canal resulting in herpes zoster formation. To the best of our knowledge, coexistence of RHS with VZV brainstem encephalitis is extremely rare. This case may widen our knowledge for the mechanism of VZV infection spreading into CNS. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

This study found a positive correlation between dual commitment and positive industrial relations climate while a negative correlation between dual commitment and negative industrial relations climate according to a questionnaire survey with 610 samples in several Wuhan's private enterprises. With a further research by using the Logistic regression model, the affective commitment, normative commitment in organization commitment as well as the member's affection and member's benefits have a remarkable positive impact on positive industrial relations climate, while economic commitment and choice commitment in organization commitment as well as member's affection and member's benefits have a remarkable negative impact on negative industrial relations climate. This essay is conducive to both a correct understanding of unions for the managers of private enterprises and the creation of a harmonious industrial relations climate for the unions.

Background Previous studies have demonstrated that the consumption of green tea inhibits the growth of various cancers. Most cancers are believed to be initiated from and maintained by a small population of cancer stem-like cells (CSC) or tumor-initiating cells (TIC) that are responsible for tumor relapse and chemotherapeutic resistance. Although epigallocathechin gallate (EGCG), the most abundant catechin in green tea, has been reported to induce growth inhibition and apoptosis in some cancer cells, its effect on CSC is undefined. In this study, we enriched CSC by the sphere formation, and provided an efficient model for further experiments. Using this method, we examined the effects of EGCG regulating the nasopharyngeal carcinoma (NPC) CSC and attempted to elucidate the possible mechanisms. Methods NPC TW01 and TW06 cell lines were enriched by sphere formation and characterized their phenotypical properties, such as invasion capacity, epithelial-mesenchymal transition (EMT) and gene expression were analyzed by quantitative real-time reverse transcription polymerase chain reaction (q-RT-PCR). EGCG-induced growth inhibition in the parental and sphere-derived cells was determined by MTT and bromodeoxyuridine (BrdU) assay. EGCG-induced apoptosis was analyzed by flow cytometry with Annexin V and PI staining. The effects of EGCG on sphere-derived cell tumorigenicity, migration and invasion were determined by soft agar assay, wound healing, and cell invasion assay. The alternation of protein expression regulated by EGCG on these sphere-derived cells was assessed by immunofluorescence staining and western blot. Results NPC sphere-derived cells grown in serum-free non-adherent culture showed increased expression of stem cell markers and EMT markers compared to parental cells grown in conventional culture. Although EGCG induced growth inhibition and apoptosis in the parental cells in a dose-dependent manner, it was not as effective against spheres. However, EGCG potently inhibited sphere formation and can eliminate the stem cell characteristics of NPC and inhibit the epithelial-mesenchymal transition (EMT) signatures. Conclusions Overall, these findings show that NPC cells with sphere formations possess the properties of CSC. Using this model, we found that EGCG regulated NPC CSC, their self-renewal capacity, and inhibited their invasive characteristics. It supports the pivotal role of EGCG as a dietary compound targeting NPC and may decrease recurrence and metastasis in nasopharyngeal carcinoma cells.

Background Risk factors of postoperative atrial fibrillation (AF) in patients undergoing general thoracic operations have been extensively studied. This study investigated risk factors for intraoperative AF. Identification of patients vulnerable for intraoperative AF during lung operations will benefit from improved preoperative and intraoperative management that will ultimately decrease intraoperative complications. This study retrospectively evaluated the risk factors for intraoperative AF during lung operations. Methods Medical records of 10,638 patients who underwent lung operations from January 1, 2006, to May 20, 2011, at the Shanghai Chest Hospital were reviewed. The analysis excluded 75 patients with preoperative AF or nonsinus rhythm or who were taking antiarrhythmic drugs before the operation. The final analysis included 10,563 patients. Univariate and multivariate analyses were performed to identify risk factors for intraoperative AF. Results The overall incidence of intraoperative AF was 3.27% (346 of 10,563). Multivariable logistic analysis identified increasing age, male sex, lung cancer, general anesthesia plus paravertebral block, open operation, resection of one or more lobes, and increased operation time as risk factors of intraoperative AF. In 40.73% of patients, intraoperative AF occurred during lymph node dissection. Conclusions We identified seven risk factors for intraoperative AF in patients receiving lung operations. These findings may eventually help us to improve preoperative and intraoperative management to minimize intraoperative AF.

This chapter outlines key considerations for constructing and implementing an EST database. Instead of showing the technological details step by step, emphasis is put on the design of an EST database suited to the specific needs of EST projects and how to choose the most suitable tools. Using TBestDB as an example, we illustrate the essential factors to be considered for database construction and the steps for data population and annotation. This process employs technologies such as PostgreSQL, Perl, and PHP to build the database and interface, and tools such as AutoFACT for data processing and annotation. We discuss these in comparison to other available technologies and tools, and explain the reasons for our choices.

The electronic structures of various Cu+ luminescence centers in wurtzite ZnS are studied by using first-principles linear muffin-tin-orbital method combining atomic sphere approximation. The results for ZnS:Cu:Cl and ZnS:Cu:Al show that Cu acceptor states are anomalously deep (beyond 2.7 eV above the top of valence band) and located near the bottom of conduction band in these two cases. On the other hand, the results for ZnS:Cu with sulfur vacancies manifest that the Cu+ center is an associated center, whose Cu d-like states are situated above the top of valence band.

The band-structure of BaBiO3 has been calculated by using LMTO-ASA method to a supercell, in which the breathing-mode displacements of oxygen atoms and two oxidation states of Bi were considered. The results indicate that BaBiO3 is a semiconductor with a gap of 1.5 eV, which, unlike previous calculations, is essentially consistent with experiments.

Background: In treating juvenile-onset laryngeal papillomatosis, the most difficult aspect is preventing recurrence. After a single treatment, recurrence can begin after as soon as 20 days and the recurrent rate can be higher than 90%. The causes of recurrence include the presence of mucosal cells infected with papilloma virus, which are undetectable with the naked eyes, and surgery-induced infection. Photodynamic therapy (PDT) could effectively solve this problem. Virus-infected cells have a very high metabolic energy for capturing and internalizing the photosensitizer, which, after light stimulation, subsequently induces active oxygen species inside the nucleus, which kill infected cells. The second generation of photosensitizer agents (PA) are locally applied to avoid the intravenous systemic damage caused by first-generation PAs, and this method is widely used for the treatment of genital warts to very good effect. Methods: We used the photodynamic method to treat laryngeal papillomatosis in children and obtained significant efficacy. We followed three juvenile subjects with recurrent laryngeal papillomatosis through a course of treatment (each course includes three PDT sessions), with a follow-up after 6 months. Results: The characteristic procedures involve exposing the larynx with a laryngoscope and using low-temperature plasma technology to visualize the tumor resection, as the effects of plasma technology can reduce postoperative laryngeal edema and reduce intraoperative metastasis. PDT was performed during the first surgery, 20 days after and 30 days after surgery. At the 6-month follow-ups, there was no recurrence. Conclusion: This was the world's first successful reported case of the use of PDT treatment for juvenile laryngeal papillomatosis.

To study the effects of tetrandrine on portal hypertensive gastric mucosal lesions.Portal hypertensive models were induced in Wistar rats by 60% CCl4 3 mL/kg body weight through subcutaneous injection, once every 4 d for 56 d. The animals were randomly divided into portal hypertension, tetrandrine and propranolol groups and subsequently, treated by normal saline, tetrandrine and propranolol respectively for 15 d. Some healthy rats were used as control group. Portal venous pressure (PVP), gastric mucosal prostaglandin E2 (PGE2) content, gastric mucosal blood flow (GMBF), gastric adherent mucus (GAM), ALT, ALP and serum total bilirubin (STB), were measured and liver tissues were observed histologically.In tetrandrine group and propranolol group, PVP was significantly lower (1.43 ± 0.13, 1.45 ± 0.12 vs 1.89 ± 0.18 kPa; P0.01) and gastric mucosal PGE2 content (138.59 ± 12.68, 129.98 ± 14.31 vs 104.65 ± 12.97 pg/mg; P0.01), GMBF (11.80 ± 3.47, 10.54 ± 3.63 vs 6.61 ± 2.82 mL·h·kg; P0.05) and GAM (3.01 ± 0.15, 2.98 ± 0.21 vs 2.24 mg ± 0.26 mg; P0.01) was significantly higher than that in portal hypertension control group. In tetrandrine group intrahepatic proliferative fibrous tissues were reduced and serum ALT (47.67 ± 25.90 vs 189.33 ± 41.21 King U; P0.01), ALP (0.22 ± 0.04 vs 0.31 ± 0.06 μmol·s(-1)/L; P0.01) and STB (4.75 ± 0.76 vs 11.12 ± 2.93 μmol/L; P0.01) were lowered as compared with those in portal hypertension control group. ALT (209.34 ± 36.91 vs 189.33 ± 41.21 King U; P0.05) and STB (11.63 ± 3.01 vs 11.12 ± 2.93 μmol/L; P0.05) in propranolol group were not different from that in portal hypertension control group, but it showed more marked hepatocellular degeneration and necrosis and elevation of ALP (0.46 ± 0.05 vs 0.31 ± 0.06 μmol·s(-1)/L; P0.01).Tetrandrine can improve the functions of gastric mucosa and liver, and facilitate the absorption of intrahepatic proliferative fibrous tissues. Propranolol can aggravate hepatosis though it may improve portal hypertensive gastric mucosal lesions.

One thousand two hundred twenty-six cases of colorectal cancer were treated surgically between 1956 and 1978. Seven hundred ninety-eight cases (65.08 per cent) were rectal, 74.3 per cent of which were located extraperitoneally. Dukes' C2 cases and cases with distant metastasis constituted 39.15 per cent, and Dukes' A cases, 9.22 per cent. Resectability rate was 75.1 per cent (77.6 per cent for rectal cancer). Two hundred and four cases (32.96 per cent) of rectal excision were restorative resections. Of the combined excisions for extraperitoneal lesions in females, 84.8 per cent were posterior pelvic exenterations. The overall operative mortality rate was 2.93 per cent. The mortality rate for 921 cases of resection was 1.73 per cent, for rectal resection, 0.8 per cent, and for curative rectal resection, 0.63 per cent. The follow-up rate was 94.13 per cent. The five-and ten-year survival rates for rectal resection were 53.08 +/- 2.29 per cent and 47.65 +/- 2.44 per cent; for curative rectal resection. 66.91 +/- 2.54 per cent and 60.27 +/- 3.03 per cent; and for Dukes' A cases, 98.05 +/- 1.35 per cent and 96.39 +/- 2.13 per cent. The five-and ten-year survival rates for colonic resection were 59.79 +/- 2.04 per cent and 52.18 +/- 3.49 per cent; for curative colonic resection, 72.79 +/- 3.39 per cent and 62.06 +/- 4.17 per cent; and for Dukes' A cases, both 100 per cent. Besides the extent of spread and degree of malignancy of a lesion, the local immunologic reaction of the host is also important in prognosis. The more lymphocytic infiltration in and around the cancer, the more follicular hyperplasia and sinus histiocytosis in regional lymph nodes, the better is the prognosis. The problem of anal preservation in radical resection of rectal cancer and the problem of improvement of results in the treatment of extraperitoneal rectal cancer are discussed in detail.