Risk factors for perioperative blood transfusion in patients undergoing total laparoscopic hysterectomy.

PURPOSE: The goal is to identify risk factors associated with receiving a blood transfusion during the perioperative period in patients who undergo total laparoscopic hysterectomy (TLH) using a large-scale national database. METHODS: In this retrospective analysis, data from the Nationwide Inpatient Sample (NIS) was utilized to review the medical records of all patients who underwent TLH from 2010 to 2019. The researchers identified patients who had received a blood transfusion during the perioperative period and compared with those who had not. The subsequent factors associated with blood transfusion were examined: hospital characteristics (type of admission and payer, patient demographics (age and race), bed size, teaching status, location, and region of hospital), length of stay (LOS), total charges during hospitalization, in-hospital mortality, comorbidities, and perioperative complications. The data was analyzed using descriptive statistics. The independent risk factors of perioperative blood transfusion after TLH was identified by performing multivariate logistic regression. RESULTS: A total of 79,933 TLH were captured from the NIS database, among which 3433 (4.40%) patients received a perioperative blood transfusion. TLH patients affected by blood transfusion were 2 days longer hospital stays (P < 0.001), higher overall costs (P < 0.001), the patients who received a transfusion after a long-term hospitalization had a significantly higher rate of mortality (0.5% vs. 0.1%; P < 0.001). Perioperative blood transfusion after TLH was associated with chronic blood loss anemia, deficiency anemia, coagulopathy, congestive heart failure, fluid and electrolyte disorders, renal failure, metastatic cancer, sepsis, weight loss, deep vein thrombosis, gastrointestinal hemorrhage, shock, acute myocardial infarction, and pneumonia, stroke, hemorrhage, pulmonary embolism, and disease of the genitourinary system. CONCLUSION: Studying the risk factors of perioperative blood transfusion after TLH is advantageous in order to ensure proper management and optimize outcomes.

Influence of inoculating white-rot fungi on organic matter transformations and mobility of heavy metals in sewage sludge based composting.

White-rot fungi, Phanerochaete chrysosporium was inoculated to sewage sludge composting. Its effect on transformation of organic matter and mobility of heavy metals (Zn, Pb, Cu, and Ni) was studied. Detailed sampling was performed to measure C contents in humic extracts (HE), humic acids (HAs), fulvic acids (FAs), humin and distribution of heavy metals, including acid exchangeable fraction (AE), reducible fraction (RED), oxidization fraction (OXI) and residual fraction (RES). In our study, it is evident that the HE, HAs increased obviously and hydrolyzed humin decreased markedly in inoculation. The stabilization rate ((OXI+RES)/(AE+RED)) of Zn, Pb, Cu, and Ni was 20.31%, 7%, 14.3% and 19.79% higher in inoculating reactor. Additionally, the changes of heavy metals fractions could be explained by the organic variables. The results of this study demonstrated that Phanerochaete chrysosporium passivates the heavy metal by provoking the formation of humus.

Comparison of bioleaching and electrokinetic remediation processes for removal of heavy metals from wastewater treatment sludge.

Heavy metals prevent the growing amount of sewage sludge from being disposed as fertilizeron land. The electrokinetic remediation and bioleaching technology are the promising methods to remove heavy metals. In recent years, some innovation has been made to achieve better efficiency, including the innovation of processes and agents. This paper reviews the development of the electrokinetic remediation and bioleaching technology and analyses their advantages and limitation, pointing out the need of the future research for the heavy metals-contaminated sewage sludge.

Melatonin synergizes the chemotherapeutic effect of 5-fluorouracil in colon cancer by suppressing PI3K/AKT and NF-κB/iNOS signaling pathways.

5-Fluorouracil (5-FU) is one of the most commonly used chemotherapeutic agents in colon cancer treatment, but has a narrow therapeutic index limited by its toxicity. Melatonin exerts antitumor activity in various cancers, but it has never been combined with 5-FU as an anticolon cancer treatment to improve the chemotherapeutic effect of 5-FU. In this study, we assessed such combinational use in colon cancer and investigated whether melatonin could synergize the antitumor effect of 5-FU. We found that melatonin significantly enhanced the 5-FU-mediated inhibition of cell proliferation, colony formation, cell migration and invasion in colon cancer cells. We also found that melatonin synergized with 5-FU to promote the activation of the caspase/PARP-dependent apoptosis pathway and induce cell cycle arrest. Further mechanism study demonstrated that melatonin synergized the antitumor effect of 5-FU by targeting the PI3K/AKT and NF-κB/inducible nitric oxide synthase (iNOS) signaling. Melatonin in combination with 5-FU markedly suppressed the phosphorylation of PI3K, AKT, IKKα, IκBα, and p65 proteins, promoted the translocation of NF-κB p50/p65 from the nuclei to cytoplasm, abrogated their binding to the iNOS promoter, and thereby enhanced the inhibition of iNOS signaling. In addition, pretreatment with a PI3K- or iNOS-specific inhibitor synergized the antitumor effects of 5-FU and melatonin. Finally, we verified in a xenograft mouse model that melatonin and 5-FU exerted synergistic antitumor effect by inhibiting the AKT and iNOS signaling pathways. Collectively, our study demonstrated that melatonin synergized the chemotherapeutic effect of 5-FU in colon cancer through simultaneous suppression of multiple signaling pathways.

Effects of constant pH and unsteady pH at different free ammonia concentrations on shortcut nitrification for landfill leachate treatment.

On the basis of achieving shortcut nitrification in a lab-scale SBR, the effects of constant pH and unsteady pH at different free ammonia concentrations on shortcut nitrification for landfill leachate treatment was investigated. The results indicate that under the condition of DO of 0.5 ± 0.2 mg/L and temperature of 30 ± 2 °C, the absolute value of nitrite accumulation increased significantly with the increase in free ammonia (FA) concentration from 5.30 to 48.67 mg/L; however, the nitrite accumulation rate remained almost constant at a constant pH of 8.0 ± 0.1. Ammonia oxidation and the nitrite accumulation become slow with the pH decreased from 8.0 ± 0.1 to 7.5 ± 0.2, and the activities of ammonia-oxidizing bacteria (AOB) and nitrite-oxidizing bacteria (NOB) were severely inhibited when the pH further decreased to 6.5. More importantly, this study confirmed that the pH decrease from 8.0 to 6.5 within a short time exhibited significant negative effect on the ammonia oxidation rather than the FA concentration.

Use of dewatered municipal sludge on Canna growth in pot experiments with a barren clay soil.

The present study evaluated the possibility of using the dewatered municipal sludge for non-agricultural purposes. The sludge was amended with soil and was applied at 0, 165, 330, 495 and 660 t/ha to promote the growth of Canna. The results showed that the Canna growth pattern exhibited a pronounced positive growth response in the range of 165-495 t/ha, and the Canna could not survive at an amendment rate of 660 t/ha. The analysis of chlorophyll fluorescence parameters showed that sludge did no harm to Canna, while under the conditions of barren soil alone, the plants were put into nutrients stress conditions. Due to the application of sludge, the concentration of heavy metals (Cu, Zn, Cr, Cd, Pb and Ni) in soil increased. However, by planting of Canna, contents of Cd, Ni and Zn showed trends of decline; Cd and Ni have shown a significant decline in concentration, while Zn had only limit response. As a result, dewatered sludge might be used to amend the barren soil and Canna could be used for phytoremediation of sludge.

Effects of temperature on simultaneous nitrification and denitrification via nitrite in a sequencing batch biofilm reactor.

A laboratory scale experiment was described in this paper to enhance biological nitrogen removal by simultaneous nitrification and denitrification (SND) via nitrite with a sequencing batch biofilm reactor (SBBR). Under conditions of total nitrogen (TN) about 30 mg/L and pH ranged 7.15-7.62, synthetic wastewater was cyclically operated within the reactor for 110 days. Optimal operation conditions were established to obtain consistently high TN removal rate and nitrite accumulation ratio, which included an optimal temperature of 31 degrees C and an aeration time of 5 h under the air flow of 50 L/h. Stable nitrite accumulation could be realized under different temperatures and the nitrite accumulation ratio increased with an increase of temperature from 15 to 35 degrees C. The highest TN removal rate (91.9%) was at 31 degrees C with DO ranged 3-4 mg/L. Process control could be achieved by observing changes in DO and pH to judge the end-point of oxidation of ammonia and SND.