Comparison of oncological benefits of deep neuromuscular block in obese patients with gastric cancer (DEBLOQS_GC study): A study protocol for a double-blind, randomized controlled trial.

PURPOSE: Many studies have demonstrated the advantage of maintaining intraoperative deep neuromuscular block (NMB) with sugammadex. This trial is designed to evaluate the impact of muscle relaxation during laparoscopic subtotal gastrectomy on the oncological benefits, particularly in obese patients with gastric cancer. MATERIALS AND METHODS: This is a double-blind, randomized controlled multicenter prospective trial. Patients with clinical stage I-II gastric cancer with a body mass index of 25 and over, who undergo laparoscopic subtotal gastrectomy will be eligible for trial inclusion. The patients will be randomized into a deep NMB group or a moderate NMB group with a 1:1 ratio. A total of 196 patients (98 per group) are required. The primary endpoint is the number of harvested lymph nodes, which is a critical index of the quality of surgery in gastric cancer treatment. The secondary endpoints are surgeon's surgical condition score, patient's sedation score, and surgical outcomes including peak inspiratory pressure, operation time, postoperative pain, and morbidity. DISCUSSION: This is the first study that compares deep NMB with moderate NMB during laparoscopic gastrectomy in obese patients with gastric cancer. We hope to show the oncologic benefits of deep NMB compared with moderate NMB during subtotal gastrectomy. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov (NCT03196791), date of registration: October 10, 2017.

Optimizing the industrial wastewater pretreatment by activated carbon and coagulation: effects of hydrophobicity/hydrophilicity and molecular weights of dissolved organics.

This study addresses industrial wastewater treatment to remove dissolved organic compounds (DOC) using Fenton and coagulation processes, followed by granular activated carbon (GAC), and powdered activated carbon (PAC) as a pretreatment before reverse osmosis (RO). The effects of the hydrophobic / hydrophilic fractions and the molecular weights (MW) of the organics on DOC removal were tested and used to optimize the combination process. The raw wastewater (RWW) had a dominant hydrophobic fraction, as determined by polymeric resins Amberlite XAD-4. High performance liquid chromatography tandem mass spectrometry (HPLC/MS/MS) results showed that MW of organics were 256, 172, 258, 146, 392, 321, 182, 373, 276, 365, 409 and 453 in increasing order of hydrophobicity. GAC had higher adsorption capacity and was more selective for hydrophobic DOC removal than PAC. The removal efficiency of DOC by PAC and GAC was decreased after Fenton treatment, which decreased the hydrophobic fraction. Coagulation with ferric chloride efficiently removed the non-ionic hydrophilic and anionic hydrophilic organics. The coagulant doses selected as a pretreatment before GAC were 2.1 and 15.5 mg Fe(III)/mg DOC. The effluent total organic carbon (TOC) trends were correlated with the hydrophobic and hydrophilic fractions by using a rapid small-scale column test (RSSCT) for GAC breakthrough with a scale down factor of 5. GAC preferentially adsorbed the hydrophobic and the cationic hydrophilic organics. The effluent TOC trend could be divided into four stages: maximum adsorption, hydrophobic stage, exhaustion, and biological. The TOC removal after the exhaustion stage was almost equal to the hydrophilic fraction of TOC. Therefore these results demonstrated that the combination of coagulation and GAC adsorption was a highly efficient process for reducing DOC.