Microbial denitrification is a major pathway for nitrogen removal from water bodies. However, denitrification is often difficult to continue when there is a lack of microbially available organic matter in the water body to serve as electron donors. In recent years, studies have shown that some denitrifying bacteria can directly utilize photoelectrons generated by sunlight-excited semiconductor minerals or natural organic matter for denitrification without the need for bioavailable organic matter as electron donors. This process is defined as microbial photoelectrotrophic denitrification. The discovery of microbial photoelectrotrophic denitrification phenomenon reshapes the previous knowledge about the chemoheterotrophic mode of denitrifying bacteria and broadens the pathway of nitrogen removal by the new photoelectrotrophic metabolism, which is of great significance to our understanding and exploration of sunlight-driven nitrogen cycling process. In this paper, we comprehensively sort out the existing research reports in the field of microbial photoelectrotrophic denitrification, systematically summarize the principle and the current research progress of microbial photoelectrotrophic denitrification, deeply analyze the problems and challenges faced by this technology, and make an outlook on the future research directions and application prospects of this technology, providing a reference for the further research and application of this technology.
Denitrification/physiology* ; Nitrogen/isolation & purification* ; Bacteria/metabolism* ; Sunlight ; Phototrophic Processes

With the increasing incidence and mortality of cancer, the limitations of conventional therapies have become increasingly apparent, necessitating the development of more precise immunotherapeutic approaches. mRNA vaccines have emerged as a prominent research focus in cancer immunotherapy due to their advantages in antigen design, rapid production, and enhanced safety profiles. This article reviews the advances in molecular design optimization of mRNA cancer vaccines such nucleoside modification, 5’-/3’-untranslated region (UTR) optimization and open reading frame (ORF) engineering to enhance efficacy and stability), key antigen types (viral antigens, tumor-associated antigens, tumor-specific antigens, and immunomodulators), delivery systems, and clinical research. By expressing specific antigens in vivo, these vaccines activate immune recognition and elimination of cancer cells. Currently, multiple mRNA vaccines have entered clinical trials, often in combination with immune checkpoint inhibitors or other immunotherapies. Despite their promising potential, challenges such as mRNA instability, difficulty in targeted delivery, immune tolerance, and tumor immune evasion still exist. Future breakthroughs will require advances in neoantigen prediction, targeted delivery, and combination therapy.

Humans ; Diabetes Mellitus, Type 2/surgery* ; Gastrectomy ; Gastric Bypass ; Obesity/surgery* ; Obesity, Morbid/surgery* ; Treatment Outcome ; Laparoscopy ; Retrospective Studies

Objective:To investigate the consistency and correlation of the respiratory synchronization tracking and fiducial marker respiratory synchronization tracking in the Cyberknife stereotactic body radiotherapy (SBRT) with the diaphragm as the tracking target.Methods:A total of 11 patients hospitalized at Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from April 2018 to November 2019 were enrolled, including 8 cases of lung cancer, 2 cases of liver cancer with lung metastasis and 1 case of colorectal cancer with lung metastasis. All enrolled cases used fiducial marker tracking plan (RT) and diaphragm contour tracking plan (DT), and then all received tumor visualization simulation tests. Bland-Altman method was used to make the consistency analysis of the offset in the visualization tests process of 2 tracking plans at each respiratory time point. The minimum tolerance distance, uncertainty and average standard deviation and maximum standard deviation in the optimal model state plans were compared between the both plans by using t test. Results:Compared with RT, the translational standard deviations of DT tracking were listed as follows: head-foot direction (0.4±2.9) mm, left-right direction (0.3±4.4) mm, anterior-posterior direction (-1.8±6.8) mm. The Bland-Altman method showed that the consistency between RT and DT was better in the head-foot and left-right directions, and worse in the anterior-posterior direction; the synchronization was only better in the head-foot direction, and worse in both the left-right and anterior-posterior directions. Results of the model quality comparison showed that the uncertainty of RT was higher than that of DT, and the difference was statistically significant [(23±6)% vs. (9±4)%, t=-5.24, P = 0.001], while the differences of the minimum tolerance distance, average standard deviation and maximum standard deviation were not statistically significant (all P>0.05). Conclusions:Patients who use respiratory synchronization Cyberknife SBRT with the diaphragm as the tracking target have better consistency and synchronization in the head-foot direction, but worse in the left-right and anterior-posterior directions. Under the corresponding marginal margin of the target area in the left-right direction, for tumors near the diaphragm that are not visible in the visual test, it is potentially feasible to use the diaphragm as a tracking target to implement respiratory synchronization SBRT. For larger motion amplitudes in the left-right and anterior-posterior directions, more caution is required.

Objective: To evaluate the long-term healing rate of transsphincteric anal fistula treated with anal fistula plug procedure and the risk factors affecting the healing of anal fistula. Methods: A retrospective case-control study was conducted to analyze the clinical data of 207 patients with transsphincteric anal fistulas who received anal fistula plug procedure at the Department of General Surgery, Beijing Chaoyang Hospital of Capital Medical University from August 2008 to September 2012. Inclusion criteria: (1) consistent with the diagnosis of transsphincteric anal fistula: the anal fistula passed through the internal and external sphincter; (2) complete data; (3) initial treatment with anal fistula plug procedure. Exclusion criteria: (1) acute rectal or perianal infection or poorly controlled focal infection; (2) recent incision and drainage of perianal abscess or spontaneous rupture of abscess; (3) patients with malignant tumor; (4) patients with Crohn′s disease or ulcerative colitis; (5) patients with heart, liver, brain, lung or renal insufficiency; (6) cachexia due to various chronic wasting diseases; (7) patients could not tolerate surgery. Patients were followed up for anal fistula healing. The cumulative healing rate of patients with transsphincteric anal fistula was plotted using the Kaplan-Meier method, and the factors affecting anal fistula healing were explored by univariate and multivariate logistic regression analysis. Results: There were 186 males and 21 females with age of 15 to 69 (mean 38) years. The duration of anal fistula was 3-60 (mean 15) months. Three patients had a history of previous episodes of perianal abscess and underwent incision and drainage of perianal abscess (all more than 3 months). During follow-up ending on October 31, 2018, 72 patients (34.8%) were lost to follow-up. Among 135 patients who were successfully followed up, the average follow-up period was 96 (75-124) months. Seventy-five patients had anal fistula healing, with healing rate of 55.6%. Kaplan-Meier survival curve showed that the healing time of anal fistula was prolonged and finally stabilized at 55.6%. In the patients who failed initial treatment with anal fistula plug packing, there were 6 cases whose anal fistula healed spontaneously without other treatment. Among them, 3 cases healed spontaneously 2 years and 3 cases 3 years after operation without recurrence. From 2008 to 2012, the annual healing rates of anal fistula plug treatment were 3/6, 61.5% (24/39), 42.1% (24/57), 12/15 and 12/18, respectively. Multivariate logistic regression analysis showed that the duration of anal fistula≥6 months (OR=3.187, 95% CI: 1.361-7.466, P=0.008) was an independent risk factor for anal fistula healing after treatment with anal fistula plug. Conclusion The long-term efficacy of anal fistula plug procedure in the treatment of transsphincteric anal fistula is positive, and this procedure should be implemented as soon as possible.

Objective:To analysis the clinical characteristics of The clinical characteristics of using automated external defibrillation in the public place,To explore the feasibility and effectiveness of AED application in public places in China.Methods:From January 2014 to April 5, 2019, 54 cases of on-site emergency medical records of AED use in public places in China were analyzed retrospectively from three aspects: patient and AED user attributes, and AED clinical performance.Results:After field application of AED analysis, 54 patients did not have out of hospital cardiac arrest in 9 patients; cardiac arrest in 45 patients, cerebral resuscitation in 40 patients (88.9%), death in 5 patients (11.1%), one of them died in hospital. The accuracy of AED for defibrillation rhythm recognition and defibrillation recommendations was 100%. The success rate of shock to VF was 97.22%, and that of non pulse VT was 100%. The data shows that AEDs of different brands show clinical effectiveness in the core indicators of work. The operation level of the rescuer determines the critical time of AED shock, which is closely related to the prognosis of the patient ( P<0.05) . Conclusions:AED is reliable and effective in electric shock decision and performance.The overall efficiency of AED application can be improved by strengthening training, shortening the critical time of electric shock, rational configuration and effective management.

Objective:To evaluate the long-term effects of anal fistula plug treatment on postoperative anal function in patients with trans-sphincteric perianal fistula, and identify risk factors associated with anal function.Methods:A case-control study was conducted. Clinical and follow-up data of 123 patients with trans-sphincteric perianal fistula receiving anal fistula plug treatment in Beijing Chaoyang Hospital from August 2008 to September 2012 were retrospectively analyzed. The follow-up deadline was April 30, 2020. The Wexner score for incontinence was used to evaluate pre-and postoperative anal function (range from 0 to 20, with higher score representing worse function). The potential risk factors affecting postoperative anal function, including gender, age, fasting blood glucose, diabetes, smoking, alcoholism, location of external opening of anal fistula, surgeon expertise and operation time, were statistically analyzed.Results:Among the 123 patients, 114 were male and 9 were female, the median age was 39 (15-69) years, body mass index (BMI) was (26.2±3.9) kg/m 2, and the median distance between the external opening of anal fistula and the anal verge was 2.6 (1.0-5.0) cm. The median operation time was 30.4 (15.0-60.0) minutes. The median follow-up time was 120 (93-141) months. Sixty-nine patients (56.5%) were healed. The assessment of anal function by Wexner incontinence score showed that 33 (26.8%) patients had anal functional decline after surgery, and the postoperative median Wexner score was 1.34 (0-8), which was significantly higher than preoperative score of 0.17 (0-4) ( Z=-5.057, P<0.001). Compared with preoperative levers, postoperative subscores of flatus incontinence, liquid incontinence, solid incontinence and alteration in lifestyle were increased significantly (all P<0.05). Subgroup analysis showed that both in the healed and unhealed groups, the postoperative Wexner scores were higher than those before surgery [healed group: 1.22 (0-8) vs. 0.17 (0-1), Z=-3.796, P<0.001; unhealed group: 1.5 (0-8) vs.0.17 (0-3), Z=-3.422, P=0.001]. Univariate analysis revealed that 33 patients with postoperative anal functional decline had higher BMI, higher fasting blood glucose, higher proportion of alcoholism, longer distance between external opening of anal fistula and the anal verge, and longer operation time (all P<0.05). Multivariate logistic regression analysis testified that higher BMI (OR=1.485, 95% CI: 1.220-1.807, P<0.001) and longer distance between external opening and anal verge (OR=2.207, 95% CI: 1.276-3.220, P=0.003) were independent risk factors for postoperative anal functional decline. Conclusions:The treatment for trans-sphincteric anal fistula with anal fistula plug leads to long-term postoperative anal function decline. For patients with obesity and longer distance between external opening of anal fistula and the anal verge, this procedure should be performed with particular caution, and the anal sphincter should be preserved as much as possible during the operation.

Objective:To evaluate the long-term effects of anal fistula plug treatment on postoperative anal function in patients with trans-sphincteric perianal fistula, and identify risk factors associated with anal function.Methods:A case-control study was conducted. Clinical and follow-up data of 123 patients with trans-sphincteric perianal fistula receiving anal fistula plug treatment in Beijing Chaoyang Hospital from August 2008 to September 2012 were retrospectively analyzed. The follow-up deadline was April 30, 2020. The Wexner score for incontinence was used to evaluate pre-and postoperative anal function (range from 0 to 20, with higher score representing worse function). The potential risk factors affecting postoperative anal function, including gender, age, fasting blood glucose, diabetes, smoking, alcoholism, location of external opening of anal fistula, surgeon expertise and operation time, were statistically analyzed.Results:Among the 123 patients, 114 were male and 9 were female, the median age was 39 (15-69) years, body mass index (BMI) was (26.2±3.9) kg/m 2, and the median distance between the external opening of anal fistula and the anal verge was 2.6 (1.0-5.0) cm. The median operation time was 30.4 (15.0-60.0) minutes. The median follow-up time was 120 (93-141) months. Sixty-nine patients (56.5%) were healed. The assessment of anal function by Wexner incontinence score showed that 33 (26.8%) patients had anal functional decline after surgery, and the postoperative median Wexner score was 1.34 (0-8), which was significantly higher than preoperative score of 0.17 (0-4) ( Z=-5.057, P<0.001). Compared with preoperative levers, postoperative subscores of flatus incontinence, liquid incontinence, solid incontinence and alteration in lifestyle were increased significantly (all P<0.05). Subgroup analysis showed that both in the healed and unhealed groups, the postoperative Wexner scores were higher than those before surgery [healed group: 1.22 (0-8) vs. 0.17 (0-1), Z=-3.796, P<0.001; unhealed group: 1.5 (0-8) vs.0.17 (0-3), Z=-3.422, P=0.001]. Univariate analysis revealed that 33 patients with postoperative anal functional decline had higher BMI, higher fasting blood glucose, higher proportion of alcoholism, longer distance between external opening of anal fistula and the anal verge, and longer operation time (all P<0.05). Multivariate logistic regression analysis testified that higher BMI (OR=1.485, 95% CI: 1.220-1.807, P<0.001) and longer distance between external opening and anal verge (OR=2.207, 95% CI: 1.276-3.220, P=0.003) were independent risk factors for postoperative anal functional decline. Conclusions:The treatment for trans-sphincteric anal fistula with anal fistula plug leads to long-term postoperative anal function decline. For patients with obesity and longer distance between external opening of anal fistula and the anal verge, this procedure should be performed with particular caution, and the anal sphincter should be preserved as much as possible during the operation.

Objective: To improve synchrony tracking components of CyberKnife (tracking vest and tracking markers) and to analyze the clinical application value of the improved tracking components in CyberKnife treatment of thoracic and abdominal tumors. Methods: The tracking apron was made of knitted four-side elastic spandex cloth and suture design of Velcro, which was used to stick the tracking markers on the chest and abdomen of patients. The tracking markers added a 2 cm thick light foam block to the bottom of the original markers, and then the hook face of the Velcro was fixed to the bottom of the light foam. The improved trace component (the improved component) and the original component (the vendor component) were applied to the lung tracking treatment model, and the manufacturer components were included in the reference group. Adoption of improved components into the observation group; 20 different types of respiratory waveforms were simulated and applied to the same mold plan. After treatment, the coverage rate, mean standard deviation, maximum standard deviation and the slope of XYZ-axis vs. R correlation graph were recorded. The relevant parameters of Synchrony model and wearable time of two components were compared, and the application significances of the improved tracking component in the breathing tracking process of the CyberKnife were evaluated. Results: The maximum slope [median(interquartile range)] of XYZ-axis vs. R related graph in the reference group was 0.73 (3.89), 0.27 (0.49) and 0.34 (1.02), respectively. The maximum slope of XYZ-axis vs. R related graph in the observation group was 0.70 (2.78), 0.31 (0.30) and 0.36 (0.75), respectively. There was no statistically significant difference in the slope of XYZ-axis vs. R between the reference group and the observation group (all P > 0.05). There was no significant difference in the average standard error and maximum standard error between the reference group and the observation group [(1.7±0.4) mm vs. (1.7±0.5) mm, t=-0.382, P= 0.710; (2.0±0.6) mm vs. (1.7±0.5) mm, t=-0.877, P= 0.401], and the difference of the model coverage rate between the two groups was statistically significant [(48±18)% vs. (60±22)%, t= 2.762, P= 0.042]. The setup time of tracking components in the observation group was less than that in the reference group, and the difference was statistically significant [(44±24) s vs. (81±15) s, t=-4.310, P= 0.001]. Conclusions The improved tracking components are comparable to the manufacturer tracking components in the standard error of the Synchrony model. The improved components shorten the wear time and appropriately improve the coverage of the Synchrony model.

Objective To investigate the application value of biological mesh in the pelvic floor reconstruction of extralevator abdominoperineal excision (ELAPE) for advanced low rectal cancer (RC).Methods The retrospective cohort study was conducted.The clinicopathological data of 228 patients with advanced low RC who underwent ELAPE in the Beijing Chaoyang Hospital of Capital Medical University between August 2008 and December 2016 were collected.Of 228 patients,174 using biological mesh closure and 54 using primary closure were respectively allocated into the biological mesh group and primary closure group.Observation indicators:(1)intra-and post-operative situations;(2) postoperative complications (including short-term and long-term complications);(3) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect postoperative long-term complications,tumor recurrence or metastasis and overall survival up to December,2017.Measurement data with normal distribution were represented as（ x） ±s,and comparison between groups was analyzed using the independent-sample t test.Measurement data with skewed distribution were described as M (range),and comparison between groups was analyzed using the nonparametric test.Comparisons of count data were evaluated by the chi-square test or Fisher exact probability.Results (1)Intra-and post-operative situations:all the patients underwent successful ELAPE.The perineal operation time,time of indwelling perineal drainage-tube and hospital expenses were respectively (60 ± 50)minutes,(11.6 ± 2.4) days,(57 781± 11 337) yuan in the biological mesh group and (50±21) minutes,(8.9± 1.7) days,(53 714± 13 395)yuan in the primary closure group,with statistically significant differences between groups (t =3.327,7.691,-2.203,P＜0.05).The total operation time and duration of postoperative hospital stay were respectively (242±53) minutes,(13.0±5.0) days in the biological mesh group and (228±51) minutes,(12.0±5.0) days in the primary closure group,with no statistically significant difference between groups (t =1.701,1.309,P＞0.05).(2) Postoperative complications:26 and 19 patients in the biological mesh group and primary closure group had respectively perineal wound complications (1 patient combined with multiple complications),showing a statistically significant difference between groups (x2 =10.660,P＜0.05).The perineal wound infection,perineal hernia and disruption of perineal wound were respectively detected in 20,6,1 patients in the biological mesh group and 12,7,3 patients in the primary closure group,showing statistically significant differences between groups (x2 =3.931,5.282,P＜0.05).(3) Follow-up and survival situations:174 patients in the biological mesh group were followed up for 64 months (range,13-112 months),and 54 patients in the primary closure group were followed up for 51 months (range,23-76 months).The local recurrence rate,distal metastasis rate and overall survival rate were respectively 5.17％ (9/174),20.11％ (35/174),77.59％ (135/174) in the biological mesh group and 7.41％(4/54),24.07％(13/54),79.63％(43/54) in the primary closure group,with no statistically significant difference between groups (x2 =0.080,0.389,0.101,P＞0.05).Conclusions The biological mesh in the pelvic floor reconstruction of ELAPE for advanced low RC is safe and feasible.Compared with primary closure,biological mesh closure will extend perineal operation time and time of indwelling perineal drainage-tube,and increase hospital expenses,but doesn't affect total operation time and duration of postoperative hospital stay,meanwhile,it can also reduce the overall perineal wound complications,especially in perineal wound infection,perineal hernia and disruption of perineal wound.