Acetic acid, as a main by-product generated in the pretreatment process of lignocellulose hydrolysis, significantly affects cell growth and lipid synthesis of oleaginous microorganisms. Therefore, we studied the tolerance of Rhodotorula glutinis to acetic acid and its lipid synthesis from substrate containing acetic acid. In the mixed sugar medium containing 6 g/L glucose and 44 g/L xylose, and supplemented with acetic acid, the cell growth was not:inhibited when the acetic acid concentration was below 10 g/L. Compared with the control, the biomass, lipid concentration and lipid content of R. glutinis increased 21.5%, 171% and 122% respectively when acetic acid concentration was 10 g/L. Furthermore, R. glutinis could accumulate lipid with acetate as the sole carbon source. Lipid concentration and lipid yield reached 3.20 g/L and 13% respectively with the initial acetic acid concentration of 25 g/L. The lipid composition was analyzed by gas chromatograph. The main composition of lipid produced with acetic acid was palmitic acid, stearic acid, oleic acid, linoleic acid and linolenic acid, including 40.9% saturated fatty acids and 59.1% unsaturated fatty acids. The lipid composition was similar to that of plant oil, indicating that lipid from oleaginous yeast R. glutinis had potential as the feedstock of biodiesel production. These results demonstrated that a certain concentration of acetic acid need not to be removed in the detoxification process when using lignocelluloses hydrolysate to produce microbial lipid by R. glutinis.
Acetic Acid ; Biofuels ; Biomass ; Culture Media ; Fatty Acids ; Hydrolysis ; Industrial Microbiology ; Lignin ; chemistry ; Linoleic Acid ; Lipids ; biosynthesis ; Oleic Acid ; Rhodotorula ; metabolism

Objective? To explore the application of information technology in continuous nursing after laparoscopic gastrointestinal tumor surgery. Methods? Using convenient sampling method, we selected a total of 118 patients who underwent laparoscopic gastrointestinal tumor surgery at the Second Affiliated Hospital of Fujian Medical University from April 2015 to April 2017. They were randomly assigned into the control group and the observation group, with 59 cases in each group. Patients in the control group were treated with traditional continuous care, while patients in the observation group were treated with information technology integrated continuous care. Self-efficacy and quality of life before and after intervention were compared between the two groups using the Chinese version of the Cancer Self-Efficacy Assessment Scale and the European Five-Dimensional Health Scale. Results? There was no significant difference in self-efficacy between the two groups before intervention (P＞0.05). The overall and different dimensions of self-efficacy of the patients in the observation group were higher than those in the control group (P＜ 0.01). There was no significant difference in quality of life between the two groups before intervention (P＞0.05). The daily activity and self-care ability of the observation group were higher than those of the control group (P＜0.05). Conclusions? Compared with traditional continuous care, information technology based continuous care can improve the self-efficacy and quality of life of patients undergoing laparoscopic gastrointestinal tumor surgery, and its promotion is worthwhile.

Objective:To investigate the feasibility and safety of implementing modified tubular gastric side-overlap anastomosis in laparoscopic proximal gastrectomy.Methods:In this retrospective, descriptive case series, we analyzed clinical data of seven patients who had undergone laparoscopic proximal gastrectomy and gastrointestinal reconstruction with modified tubular gastric side-overlap anastomosis from October 2022 to March 2023 in the Second Affiliated Hospital of Fujian Medical University. The study patients comprised five men and two women aged 57-72 years and of body mass index 18.5-25.7 kg/m 2. All seven patients had preoperative gastroscopic and pathological evidence of esophagogastric junction cancer and all were found by preoperative enhanced computed tomography and/or endoscopic ultrasonography to have stage CT1–2N0M0 tumors. The main steps in the reconstruction of a modified tubular gastric side-overlap anastomosis are as follows: (1) mobilizing the lower esophagus and opening the left pleura to expand the space; (2) severing the esophagus with a linear cutter stapler; (3) creating a 3-cm-wide tubular stomach along the greater curvature; (4) creating a 5-cm guide line on the lesser curvature of the anterior wall of the tubular stomach and a small opening below the guide line; (5) rotating the esophageal stump 90° counterclockwise and making a small opening on the right posterior wall of the esophageal stump, along with using a 45-mm linear cutter stapler for esophagogastric side-to-side anastomosis under the guidance of the gastric tube and guide line ; (6) closing the common opening using barbed sutures; (7) embedding the cut edge of the esophageal stump such as to closely oppose it to the esophagus; (8) using barbed sutures to continuously suture the lower esophagus bilaterally to the anterior wall of the tubular stomach; and (9) closing the opened esophageal hiatus and pleura. The main outcome measures were intraoperative (operation time, digestive tract reconstruction time, closing the common opening time, intraoperative blood loss, and number of dissected lymph nodes), postoperative (time to passage of flatus , time to liquid diet, time to ambulation, length of postoperative hospital stay, and postoperative complications), pathological (maximum diameter of the tumor and pathological stage) and findings on follow-up. Results:Laparoscopic proximal gastrectomy with reconstruction of a modified tubular gastric side-overlap anastomosis was successfully completed in all seven patients; no conversion to laparotomy was required and there were no postoperative complications. The operation time, digestive tract reconstruction time, and closing of common opening time were 187-229, 61-79, and 7-9 minutes, respectively. Intraoperative blood loss was 15-23 ml and the number of dissected lymph nodes was 14-46 per case. Time to passage of flatus, time to liquid diet, time to ambulation, and postoperative hospital stay were 1-2, 2-3, 3-4, and 6-7 days, respectively. Postoperative pathological examination showed that the maximum tumor diameters were 1.6-3.3 cm in four patients with stage IA disease and three patients with stage IB. The seven patients were followed up for 6-11 months, during which none required routine use of proton pump inhibitors or gastric mucosal protective agents and there were no deaths or tumor recurrence/metastasis. No patients had anemia or hypoproteinemia 3 and 6 months after surgery. Six months after surgery, NRS2002 and GERDQ scores were 1-2 and 2-3, respectively. Gastroscopy showed narrow anastomoses in 6 patients with Los Angeles grade A and one patient with grade B disease. No evidence of significant bile reflux was found and no anastomotic stenosis or reflux was detected on upper gastrointestinal angiography.Conclusion:It is safe and feasible to implement modified tubular gastric side-overlap anastomosis for digestive tract reconstruction in laparoscopic proximal gastrectomy.

Objective:To investigate the feasibility and safety of implementing modified tubular gastric side-overlap anastomosis in laparoscopic proximal gastrectomy.Methods:In this retrospective, descriptive case series, we analyzed clinical data of seven patients who had undergone laparoscopic proximal gastrectomy and gastrointestinal reconstruction with modified tubular gastric side-overlap anastomosis from October 2022 to March 2023 in the Second Affiliated Hospital of Fujian Medical University. The study patients comprised five men and two women aged 57-72 years and of body mass index 18.5-25.7 kg/m 2. All seven patients had preoperative gastroscopic and pathological evidence of esophagogastric junction cancer and all were found by preoperative enhanced computed tomography and/or endoscopic ultrasonography to have stage CT1–2N0M0 tumors. The main steps in the reconstruction of a modified tubular gastric side-overlap anastomosis are as follows: (1) mobilizing the lower esophagus and opening the left pleura to expand the space; (2) severing the esophagus with a linear cutter stapler; (3) creating a 3-cm-wide tubular stomach along the greater curvature; (4) creating a 5-cm guide line on the lesser curvature of the anterior wall of the tubular stomach and a small opening below the guide line; (5) rotating the esophageal stump 90° counterclockwise and making a small opening on the right posterior wall of the esophageal stump, along with using a 45-mm linear cutter stapler for esophagogastric side-to-side anastomosis under the guidance of the gastric tube and guide line ; (6) closing the common opening using barbed sutures; (7) embedding the cut edge of the esophageal stump such as to closely oppose it to the esophagus; (8) using barbed sutures to continuously suture the lower esophagus bilaterally to the anterior wall of the tubular stomach; and (9) closing the opened esophageal hiatus and pleura. The main outcome measures were intraoperative (operation time, digestive tract reconstruction time, closing the common opening time, intraoperative blood loss, and number of dissected lymph nodes), postoperative (time to passage of flatus , time to liquid diet, time to ambulation, length of postoperative hospital stay, and postoperative complications), pathological (maximum diameter of the tumor and pathological stage) and findings on follow-up. Results:Laparoscopic proximal gastrectomy with reconstruction of a modified tubular gastric side-overlap anastomosis was successfully completed in all seven patients; no conversion to laparotomy was required and there were no postoperative complications. The operation time, digestive tract reconstruction time, and closing of common opening time were 187-229, 61-79, and 7-9 minutes, respectively. Intraoperative blood loss was 15-23 ml and the number of dissected lymph nodes was 14-46 per case. Time to passage of flatus, time to liquid diet, time to ambulation, and postoperative hospital stay were 1-2, 2-3, 3-4, and 6-7 days, respectively. Postoperative pathological examination showed that the maximum tumor diameters were 1.6-3.3 cm in four patients with stage IA disease and three patients with stage IB. The seven patients were followed up for 6-11 months, during which none required routine use of proton pump inhibitors or gastric mucosal protective agents and there were no deaths or tumor recurrence/metastasis. No patients had anemia or hypoproteinemia 3 and 6 months after surgery. Six months after surgery, NRS2002 and GERDQ scores were 1-2 and 2-3, respectively. Gastroscopy showed narrow anastomoses in 6 patients with Los Angeles grade A and one patient with grade B disease. No evidence of significant bile reflux was found and no anastomotic stenosis or reflux was detected on upper gastrointestinal angiography.Conclusion:It is safe and feasible to implement modified tubular gastric side-overlap anastomosis for digestive tract reconstruction in laparoscopic proximal gastrectomy.

Objective To analyze the anatomy of the right colonic vessels in the laparoscopic right hemicolectomy.Methods The retrospective cross-sectional study was conducted.The clinical data of 60 patients who underwent laparoscopic right hemicolectomies in the Second Affiliated Hospital of Fujian Medical University from March 2013 to October 2016 were collected.All the patients used central approach.Patients intraoperatively underwent complete mesocolic excision (CME),and vascular anatomies of the right colon were precisely distinguished through postoperatively observing video.The starting position,formation and relative spatial location of vessels were counted and analyzed,and video screenshots were used as a comments during analysis.Observation indicators:(1) superior mesenteric artery (SMA) and superior mesenteric vein (SMV):occurrence rate and relative spatial location;(2) ileocolic artery and vein:occurrence rate and relative spatial location;(3) right colonic artery and vein:occurrence rate and relative spatial location of right colonic artery,occurrence rate and distribution of right colonic vein flowed into superior vein;(4) gastrocolic venous trunk:occurrence rate and composition of the branches;(5) middle colonic artery and vein:occurrence rate and relative spatial location of middle colonic artery,occurrence rate and distritution of middle colonic vein flowed into superior vein.Measurement data were represented as proportion and percentage.Results (1) SMA and SMV:all the 60 patients appeared SMA and SMV,with an occurrence rate of 100.0％(60/60).Of 60 patients,95.0％(57/60) and 5.0％(3/60) patients' SMAs respectively were located on the left side and right side of SMVs.(2) Ileocolic artery and vein:of 60 patients,the occurrence rates of ileocolic artery and vein were 96.7％ (58/60) and 100.0％ (60/60).Relative spatial location:of 58 patients with ileocolic artery,8.6％ (5/58),31.0％ (18/58),10.3％ (6/58),6.9％(4/58),32.9％(19/58) and 10.3％(6/58) patients' ileocolic arteries were respectively located on the right ahead,anterosuperior,inferoanterior,right behind,upper posterior and lower posterior of ileocolic veins;50.0％(29/58) patients' ileocolic arteries crossed from the front of SMV,and 50.0％ (29/58) patients' ileocolic arteries ran behind the SMV.(3) Right colonic artery and vein:① Right colonic artery:of 60 patients,occurrence rate was 55.0％(33/60),including 93.9％(31/33) with 1 right colonic artery and 6.1％(2/33) with 2 right colonic arteries.A trunk made of right colonic artery and middle colonic artery was detected in 24.2％ (8/33) patients,and flowed into SMA,including 2/8 patients with 2 right colonic arteries and 6/8 with 1 right colonic artery.Relative spatial location:of 33 patients,90.9％ (30/33) occurred right colonic artery crossed from the front of SMV;9.1％ (3/33) occurred SMA located on the right side of SMV that led to no relative spatial location between right colonic artery and SMV.② Right colonic vein:of 60 patients,occurrence rate was 93.3％ (56/60),including 87.5％(49/56) with 1 right colonic vein (7 were accompanied by right colonic artery) and 12.5％ (7/56) with 2 right colonic veins.Distribution of right colonic vein flowed into superior vein:of 49 patients with 1 right colonic vein,right colonic vein respectively flowed into gastrocolic venous trunk and SMV were detected in 73.5％ (36/49) and 26.5％ (13/49) patients.Of 7 patients with 2 right colonic veins,right colonic vein flowed into SMV and gastrocolic venous trunk were detected respectively in 6/7 patients and 1/7 patients.(4) Gastrocolic venous trunk:occurrence rate was 88.3％ (53/60);11.7％ (7/60) patients had absence of gastrocolic venous trunk,and right gastric epiploic vein directly flowed into SMV.Composition of the branches of gastrocolic venous trunk:of 53 patients,3-branch or 4-branch stomach-pancreas-colon venous trunk in 54.7％ (29/53) patients was made up of right gastric epiploic vein,pancreaticoduodenal vein,right colonic vein and middle colonic vein;2-branch or 3-branch gastrocolic venous trunk in 35.9％ (19/53) patients was made up of right gastric epiploic vein,right colonic vein and middle colonic vein;2-branch stomach-pancreas venous trunk in 9.4％ (5/53) patients was made up of right gastric epiploic vein and pancreaticoduodenal vein.(5) Middle colonic artery and vein:① Middle colonic artery:60 patients appeared middle colonic artery,with an occurrence rate of 100.0％ (60/60) and 1.7％ (1/60) appeared 2 middle colonic arteries.Of 60 patients,13.3％ (8/60) patients' middle colonic artery shared the same trunk together with right colonic artery that flowed into 1 middle colonic artery,and 85.0％(51/60) appeared 1 middle colonic artery.Middle colonic artery ≤ 1 cm,from 1 to 2 cm (excluding 1 cm) and ＞2 cm occurred branch at running out of neck of pancreas were detected in 15.7％ (8/51),66.7％ (34/51) and 66.7％ (34/51)patients,respectively.② Middle colonic vein:56 of 60 patients appeared middle colonic vein,with an occurrence rate of 93.3％(56/60),and 80.3％(45/56),16.1％(9/56) and 3.6％(2/56) patients appeared respectively 1,2 and 3 middle colonic veins.Distribution of middle colonic vein flowed into superior vein:45 patients appeared 1 middle colonic vein,55.6％ (25/45) and 44.4％ (20/45) middle colonic veins respectively flowed into SMV and gastrocolic venous trunk;9 patients appeared 2 middle colonic veins,7/9 middle colonic veins flowed into SMV and gastrocolic venous trunk and 2/9 middle colonic veins flowed into SMV;2 patients appeared 3 middle colonic veins,1 and 2 middle colonic veins respectively flowed into gastrocolic venous trunk and SMV.Conclusion Vascular anatomical variations of the right colon are complex in the laparoscopic right hemicolectomy,and anatomies of the surgical thunk and Helen trunk are difficult and core issue in operation.

Objective To evaluate the safety and efficacy of botulinum toxin type A for injection in the treatment of post-stroke upper limb spasticity (dosage was 200 U,or 240 U if combined with thumb spasticity).Methods The study was a multi-center,stratified block randomized,double-blind,placebocontrolled trial.All the qualificd subjects were from 15 clinical centers from September 2014 to February 2016.They were randomized (2∶1) to injections of botulinum toxin type A made in China (200-240 U;n =118) or placebo (n =60) in pivotal phase after informed consent signed.The study was divided into two stages.The pivotal trial phase included a one-week screening,12-week double-blind treatment,followed by an expanded phase which included six-week open-label treatment.The tone of the wrist,finger,thumb flexors was assessed at baseline and at weeks 0,1,4,6,8,12,16 and 18 using Modified Ashworth Scale (MAS),disability in activities of daily living was rated using the Disability Assessment Scale and impaction on pain,muscle tone and deformity was assessed using the Global Assessment Scale.The primary endpoint was the score difference between botulinum toxin type A and placebo groups in the tone of the wrist flexor using MAS at six weeks compared to baseline.Results Muscle tone MAS score in the wrist flexor of botulinum toxin type A and placebo groups at six weeks changed-1.00 (-2.00,-1.00) and 0.00 (-0.50,0.00) respectively from baseline.Botulinum toxin type A was significantly superior to placebo for the primary endpoint (Z =6.618,P ＜ 0.01).The safety measurement showed 10 subjects who received botulinum toxin type A had 13 adverse reactions,with an incidence of 8.47％ (10/118),and three subjects who received placebo had three adverse reactions,with an incidence of 5.00％ (3/60) during the pivotal trial phase.All adverse reactions were mild to moderate,none serious.There was no significant difference in adverse reactions incidence between the botulinum toxin type A and the placebo groups.During the expanded phase three subjects had four adverse reactions and the incidence was 1.95％.All adverse reactions were mild,none serious.Conclusion Botulinum toxin type A was found to be safe and efficacious for the treatment of post-stroke upper limb spasticity.Clinical Trial Registration:China Drug Trials,CTR20131191

Objective:To investigate the clinical efficacy of laparoscopic-assisted inters-phincteric resection (ISR) with different surgical approaches for low rectal cancer.Methods:The retrospective cohort study was conducted. The clinicopathological data of 90 patients with low rectal cancer who were admitted to the Second Affiliated Hospital of Fujian Medical University from January 2016 to December 2020 were collected. There were 58 males and 32 females, aged (60±9)years. Of 90 patients, 60 cases underwent laparoscopic assisted ISR with transpelvic approach, 30 cases underwent laparoscopic assisted ISR with transabdominal and transanal mixed approach. Observation indicators: (1) clinicopathological characteristics of patients with transpelvic approach and mixed approach; (2) intraoperative and postoperative conditions of patients with transpelvic approach and mixed approach; (3) postoperative complications of patients with transpelvic approach and mixed approach; (4) follow-up. Follow-up was conducted by telephone interview and outpatient examination once every 3 months within postoperative 3 years, once every six months in the postoperative 3 to 5 years and once a year after postoperative 5 years to detect tumor recurrence and metastasis, and survival of patients.Follow-up was up to March 2021 or patient death. Measurement data with normal distribution were represented as Mean± SD, and the t test was used for comparison between groups. Measurement data with skewed distribution were expressed as M(range), and comparison between groups was conducted using the non-parametric Mann-Whitney U test. Count data were expressed as absolute numbers or percentages, and comparison between groups was performed using the chi-square test or Fisher exact probability. Comparison of ordinal data was analyzed by the non-parametric rank sum test. Kaplan-Meier method was used to draw survival curves and calculate survival rates, and survival analysis was performed by the Log-Rank test. Results:(1) Clinicopathological characteristics of patients with transpelvic approach and mixed approach. The sex (males, females), distance from the distal margin of tumor to anal margin were 34, 26, (4.5±0.5)cm for patients with transpelvic approach, versus 24, 6, (3.5±0.5)cm for patients with mixed approach, respectively, showing significant differences between them ( χ2=4.75, t=8.35, P<0.05). (2) Intraoperative and postoperative conditions of patients with transpelvic approach and mixed approach. The operation time, volume of intraoperative blood loss, distance from the postoperative anastomosis to anal margin were (187±9)minutes, 50(range, 20?200)mL, (3.4±0.7)cm for patients with transpelvic approach, versus (256±12)minuets, 100(range, 20?200)mL, (2.6±0.7)cm for patients with mixed approach, showing significant differences between them ( t=?26.99, Z=?2.48, t=4.67, P<0.05). None of the 90 patients had a positive distal margin. The stoma reversal rates of patients with transpelvic and mixed approach were 93.3%(56/60) and 90.0%(27/30), respectively. Of the 60 patients with transpelvic approach, 3 cases had no stoma reversal due to anastomotic complications, and 1 case was not yet to the reversal time. Of the 30 patients with mixed approach, 2 cases had no stoma reversal due to anastomotic complications, and 1 case was not yet to the reversal time. The 1-, 3-month Wexner scores after stoma reversal were 15(range, 12?17), 12(range, 10?14) for patients with transpelvic approach, versus 16(range, 14?18), 14(range, 12?16) for patients with mixed approach, showing significant differences between them ( Z=?4.97, ?5.49, P<0.05). The 6-month Wexner score after stoma reversal was 10(range, 9?12) for patients with transpelvic approach, versus 11(range, 8?12) for patients with mixed approach, showing no significant difference between them ( Z=?1.59, P>0.05). (3) Postoperative complications of patients with transpelvic approach and mixed approach. The complications occurred to 16 patients with transpelvic approach and 9 patients with mixed approach, respectively, showing no significant difference between them ( χ2=0.11, P>0.05). Cases with postoperative anastomotic fistula, cases with anastomotic bleeding, cases with anastomotic stenosis, cases with intestinal obstruction, cases with incision infection, cases with urinary retention, cases with pelvic infection, cases with pulmonary infection, cases with incisional hernia, cases with chylous fistula, cases with abdominal and pelvic abscess were 5, 2, 1, 7, 0, 1, 5, 3, 1, 1, 1 for patients with transpelvic approach, versus 6, 3, 2, 2, 2, 1, 2, 3, 1, 1, 1 for patients with mixed approach, showing no significant difference between them ( P>0.05). The same patient could have multiple postoperative complications. (4) Follow-up. All the 90 patients were followed up for 27(range, 6?62)months. The follow-up time of 60 patients with transpelvic approach was 27(range, 8?62)months. The follow-up time of 30 patients with mixed approach was 28(range, 6?53)months. Of the 60 patients with transpelvic approach, 3 cases had local recurrence, 4 cases had liver metastasis, 3 cases had lung metastasis, and all of them survived with tumor. Of the 30 patients with mixed approach, 1 case had local recurrence, 2 cases had liver metastasis, 1 case had lung metastasis, and all of them survived with tumor. There was no death. The 3-year disease-free survival rates of patients with transpelvic approach and mixed approach were 84.7% and 87.9%, respectively, showing no significant difference between them ( χ2=0.39, P>0.05). Conclusions:Lapa-roscopic assisted ISR via transpelvic approach or mixed approach for low rectal cancer are safe and feasible. Compared with transanal mixed approach, the transpelvic approach of laparoscopic-assisted ISR has shorter operation time, less volume of intraoperative blood loss and longer distance from the postoperative anastomosis to anal margin.