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BackgroundThe epidemiology of upper gastrointestinal (L4) Crohn’s disease in China remains poorly characterized.AimsWe aimed to identify the clinical characteristics of L4 disease and clarify the relationship between disease characteristics at diagnosis and early outcomes.MethodsWe retrospectively enrolled 246 patients diagnosed between 2013 and 2017 and followed up for > 1 year post-diagnosis. Primary outcomes included the 1-year rates of hospitalization and abdominal surgery according to disease location and behavior.ResultsOf 80 patients with L4 disease (61, 25, and 18 with esophagogastroduodenal, jejunal, and proximal ileal involvement, respectively), none had granuloma, whereas 66.7%, 50%, 46.9%, 75%, and 70% had disease-specific endoscopic lesions in the esophagus, stomach, duodenum, jejunum, and proximal ileum, respectively. Compared to non-L4 disease, L4 disease was associated with higher rates of abdominal surgery (41.3% vs. 11.4%, P < 0.001) but similar rates of hospitalization within 1 year post-diagnosis. In L4 disease, jejunal and proximal ileal involvement was associated with stricturing behavior (P = 0.034, P < 0.001) and higher abdominal surgery rate (both: P < 0.001). Risk factors for abdominal surgery within 1 year post-diagnosis included age ≥ 40 years (OR 1.920; 95% CI 1.095–3.367), L4 phenotype (OR 6.335; 95% CI 3.862–10.390), stricturing disease (OR 3.162; 95% CI 1.103–9.866), and penetrating disease (OR 11.504; 95% CI 3.409–38.825), whereas the protective factor was female sex (OR 0.214; 95% CI 0.123–0.373).ConclusionsEarly outcomes are worse for L4 than for non-L4 disease. Jejunoileum involvement predicts stricturing disease and early surgery. More aggressive initial therapy is needed to improve L4-disease prognosis.

BackgroundDelayed colectomy can be life-threatening for patients with acute severe ulcerative colitis (ASUC). However, few biomarkers can predict the outcomes of ASUC patients before treatment. Serum procalcitonin (PCT) has been observed to be increased in ASUC patients.AimThe aim of this study was to estimate the association between serum PCT and short-term outcomes in patients with ASUC.MethodsA single-center observational study was conducted at a referral hospital from January 2012 to January 2018. Hospitalized ASUC patients, who were administered intravenous corticosteroids (IVCS), were enrolled and followed up for 6 months. The primary outcome was IVCS failure; the secondary outcome was colectomy. Relationships between indicators and clinical outcomes were assessed.ResultsOf 152 ASUC patients enrolled in this study, 81 responded to IVCS and 71 failed (62 required short-term colectomy and 9 responded to second-line rescue therapy). Serum PCT on admission was significantly higher in IVCS-failure cases and surgical cases than in medical responders. Serum PCT ≥ 0.10 µg/L (OR = 4.134, p = 0.001) predicted IVCS failure with specificity of 0.741, and the combined measurement with fecal calprotectin (FC) ≥ 1500 µg/g improved the sensitivity. Serum PCT correlated significantly with the Ulcerative Colitis Endoscopic Index of Severity (r = 0.416, p < 0.001) and FC (r = 0.384, p < 0.001).ConclusionSerum PCT on admission could be a potential early non-invasive predictive biomarker for IVCS failure in ASUC patients, and a combination of PCT and FC could improve the predictive value.

BackgroundThe role of laparoscopic-assisted natural orifice specimen extraction (LA-NOSE) colectomy in the treatment of left-sided colon cancer has not been well defined, and there remains confusion about how to conveniently exteriorize specimens through natural orifices. Therefore, we introduced a homemade invention, the Cai tube, to facilitate the extraction of specimens and compared the clinical outcomes of LA-NOSE with conventional laparoscopic (CL) colectomy for left-sided colon cancer.MethodsFrom March 2015 to August 2017, patients with left-sided colon cancer were randomly divided into LA-NOSE and CL groups. Specimens were extracted through the anus with the help of a Cai tube (Patent Number: ZL201410168748.2) in the LA-NOSE group. The primary outcome measure was postoperative pain. Secondary outcomes were the duration of operation, postoperative recovery, surgical morbidity, pathological quality of the specimen, and long-term outcomes, including 3-year overall survival, disease-free survival, local recurrence, and overall recurrence.ResultsA total of 60 patients (30 per group) were recruited for this study. None of the patients required emergency conversion to conventional laparoscopic or open surgery during the operation. The postoperative maximum pain score was significantly lower in the LA-NOSE group (mean 2.5 vs. 5.1, P = 0.001), as was the additional analgesia requirement (mean 2/30 vs. 10/30, P = 0.021). Patients in the LA-NOSE group experienced a shorter first time to passage of flatus (mean 2.2 vs. 3.1 days, P = 0.026). All patients could control their defecation at 6 months after surgery. The comparison between the two groups showed no significant differences in the operative time, bleeding volume, postoperative hospital stay, surgical morbidity rates, number of lymph nodes harvested, or resection margin status. The mean follow-up was 48 months (range 7–59) and was similar in both groups. The results showed no differences in long-term outcomes between the two groups.ConclusionIn the treatment of left-sided colon cancer, compared with conventional laparoscopic colectomy, LA-NOSE colectomy using the Cai tube exhibited lower postoperative pain, shorter recovery of gastrointestinal function, and similar long-term outcomes.Registration numberChiCTR-OOR-15007060 (http://www.chictr.org.cn/).

Quantum key distribution (QKD) enables secure key exchanges between two remote users. The ultimate goal of secure communication is to establish a global quantum network. The existing field tests suggest that quantum networks are feasible. To achieve a practical quantum network, we need to overcome several challenges including realizing versatile topologies for large scales, simple network maintenance, extendable configuration and robustness to node failures. To this end, we present a field operation of a quantum metropolitan-area network with 46 nodes and show that all these challenges can be overcome with cutting-edge quantum technologies. In particular, we realize different topological structures and continuously run the network for 31 months, by employing standard equipment for network maintenance with an extendable configuration. We realize QKD pairing and key management with a sophisticated key control centre. In this implementation, the final keys have been used for secure communication such as real-time voice telephone, text messaging and file transmission with one-time pad encryption, which can support 11 pairs of users to make audio calls simultaneously. Combined with intercity quantum backbone and ground–satellite links, our metropolitan implementation paves the way toward a global quantum network.

A novel copper(II) ion indicator based on polymer conformational change is designed and its chemo-response to the target analyte is tested in this paper. The word ‘telechelic’ in the title means that a polymer has two different fluorophores on either end. If one of them is a fluorescent donor and the other is a fluorescent acceptor, then the extent of Foerster resonance energy transfer (FRET) will depend on polymer conformation. The sensitivity of these sensors is tunable based on the chain length and the amount of the receptor on the polymer. This is revealed by the fluorescence response of 30mer, 50mer, and 100mer of poly(N-isopropyl)acrylamide with different amounts of metal chelation monomers. We also address the change in fluorescence over time due to the untangling of poly(N-isopropylacrylamide) in water. The fluorescent signal can maintain stability after metal binding. The photoluminescence results agree with the length calculation of polyelectrolytes. A fluorescent standard curve is created for the measurement of different concentrations of copper ions. The sensing limit can reach 10−10 M analytes, which is suitable for the measurement of chemicals in trace amounts in the environment.

PurposeThe aim of this meta-analysis was to compare high inferior mesenteric artery (IMA) ligation (HL) with low IMA ligation (LL) for the treatment of colorectal cancer and to evaluate the lymph node yield, survival benefit, and safety of these surgeries.MethodsPubMed, Embase, Cochrane Library, Web of Science, and China Biomedical Literature Database (CBM) were systematically searched for relevant articles that compared HL and LL for sigmoid or rectal cancer. We calculated the odds ratio (OR) with 95% confidence intervals (CIs) for dichotomous outcomes and the weighted mean difference (WMD) for continuous outcomes.ResultsIn total, 30 studies were included in this analysis. There were significantly higher odds of anastomotic leakage and urethral dysfunction in patients treated with HL compared to those treated with LL (OR = 1.29; 95% CI = 1.08 to 1.55; OR = 2.45; 95% CI = 1.39 to 4.33, respectively). There were no significant differences between the groups in terms of the total number of harvested lymph nodes, the number of harvested lymph nodes around root of the IMA, local recurrence rate, and operation time. Further, no statistically significant group differences in 5-year overall survival rates and 5-year disease-free survival rates were detected among all patients nor among subgroups of stage II patients and stage III patients, respectively.ConclusionsLL can achieve equivalent lymph node yield to HL, and both procedures have similar survival benefits. However, LL is associated with a lower incidence of leakage and urethral dysfunction. Thus, LL is recommended for colorectal cancer surgery.

Objectives To investigate the proportion of insulin‐dependent diabetes mellitus (IDDM) patients among diabetic patients undergoing total joint arthroplasty (TJA) and whether insulin dependence is associated with postoperative complications. Methods A systematic literature search was performed in EMBASE, PubMed, Ovid, Medline, the Cochrane Library, Web of Science, the China Science and Technology Journal Database, and China National Knowledge Infrastructure from the inception dates to 10 September 2019. Observational studies reporting adverse events with IDDM following TJA were included. Primary outcomes were cardiovascular complications, pulmonary complications, kidney complications, wound complications, infection, and other complications within 30 days of surgery. Secondary outcomes were the proportion of IDDM patients among diabetic patients undergoing TJA and its time trend. Results A total of 19 studies involving 85,689 participants were included. Among patients undergoing TJA, 26% of diabetic patients had IDDM. Compared with non‐insulin‐dependent diabetes (NIDDM), the incidences of cardiac arrest (risk ratio [RR], 2.346; 95% confidence interval [CI], 1.553 to 3.546), renal failure (relative risk [RR], 2.758; 95% CI, 1.830 to 4.156), deep incisional surgical site infection (RR, 1.968; 95% CI, 1.107 to 3.533), wound dehiscence (RR, 2.209; 95% CI, 1.830 to 4.156), and death (RR, 2.292; 95% CI, 1.568 to 3.349) were all significantly increased in IDDM. A significant time trend was witnessed for the prevalence of IDDM (P = 0.014). There was no statistical significance for organ/space surgical site infection, thrombotic events (deep venous thrombosis/ pulmonary embolism), and revision rates. Conclusion Insulin‐dependent diabetes is an independent high‐risk factor for increased adverse outcomes relative to NIDDM, suggesting that hierarchical and optimal blood glucose management may contribute to reducing the adverse complications after surgery for these patients. In addition, because the risk of sepsis, deep wound infection, organ/space surgical site infection, urinary tract infection, renal insufficiency, and renal failure significantly increase after TJA in IDDM patients, more active postoperative antimicrobial prophylaxis may be needed on the premise of protecting renal function. Results of the meta‐analysis.

Measurements of gaseous pollutants （03, NOx, SO2, and CO） were conducted at Dinghushan background station in southern China from January to December 2013. The levels and variations of O3, NOx, SO2, and CO were analyzed and their possible causes discussed. The annual average concentrations of 03, NOx, SO2, and CO were 24.6 ± 23.9, 12.8 ± 10.2, 4.0 ± 4.8, and 348 ± 185 ppbv, respectively. The observed levels of the gaseous pollutants are comparable to those at other background sites in China. The most obvious diurnal variation of 03 was observed in autumn, with minima in the early morning and maxima in the afternoon. The diurnal variations of SO2 showed high values during the day. The diurnal cycles of NOx showed higher values in the morning and lower values during the night. Higher CO concentrations were observed in spring followed by winter, autumn, and summer. Biomass burning, in combination with the transport of regional pollution, is an important source of CO, SO2, and NOx in spring and winter. Backward trajectories were calculated and analyzed together with corresponding pollutant concentrations. The results indicate that air masses passing over polluted areas are responsible for the high concentrations of gaseous pollutants at the Dinghushan background station.

BACKGROUND: High D-dimer (DD) is associated with short-term adverse outcomes in patients withacute coronary syndrome (ACS). In ACS patients who underwent percutaneous coronary intervention(PCI), however, the value of DD (or combined with neutrophil to lymphocyte ratio [NLR]) to predictlong-term major adverse cardiovascular events (MACEs) has not been fully evaluated. METHODS: Patients diagnosed with ACS and receiving PCI were included. The primary outcome wasMACEs. Cox proportional hazards regression and logistic regression were used to illustrate the relationshipbetween clinical risk factors, biomarkers and MACEs. Survival models were developed based onsignificant factors and evaluated by the Concordance-index (C-index). RESULTS: The final study cohort was comprised of 650 patients (median age, 64 years; 474 males),including 98 (15%) with MACEs during a median follow-up period of 40 months. According to thecut-off value of DD and NLR, the patients were separated into four groups: high DD or nonhigh DDwith high or nonhigh NLR. After adjusting for confounding variables, DD (adjusted hazard ratio[aHR]: 2.39, 95% confidence interval [CI]: 1.52–3.76) and NLR (aHR: 2.71, 95% CI: 1.78–4.11) wereindependently associated with long-term MACEs. Moreover, patients with both high DD and NLR hada significantly higher risk in MACEs when considering patients with nonhigh DD and NLR as reference(aHR: 6.19, 95% CI: 3.30–11.61). The area under curve increased and reached 0.70 in differentiatinglong-term MACEs when DD and NLR were combined, and survival models incorporating the twoexhibited a stronger predictive power (C-index: 0.75). CONCLUSIONS: D-dimer (or combined with NLR) can be used to predict long-term MACEs in ACSpatients undergoing PCI.

Background Ventricular remodeling after acute anterior wall ST-segment elevation myocardial infarction (AAMI) is an important factor in occurrence of heart failure which additionally results in poor prognosis. Therefore, the treatment of ventricular remodeling needs to be further optimized. Compound Danshen Dripping Pills (CDDP), a traditional Chinese medicine, exerts a protective effect on microcirculatory disturbance caused by ischemia-reperfusion injury and attenuates ventricular remodeling after myocardial infarction. Objective This study is designed to evaluate the efficacy and safety of CDDP in improving ventricular remodeling and cardiac function after AAMI on a larger scale. Methods This study is a multi-center, randomized, double-blind, placebo-controlled, parallel-group clinical trial. The total of 268 patients with AAMI after primary percutaneous coronary intervention (pPCI) will be randomly assigned 1:1 to the CDDP group ( n =134) and control group ( n =134) with a follow-up of 48 weeks. Both groups will be treated with standard therapy of ST-segment elevation myocardial infarction (STEMI), with the CDDP group administrating 20 tablets of CDDP before pPCI and 10 tablets 3 times daily after pPCI, and the control group treated with a placebo simultaneously. The primary endpoint is 48-week echocardiographic outcomes including left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume index (LVEDVI), and left ventricular end-systolic volume index (LVESVI). The secondary endpoint includes the change in N terminal pro-B-type natriuretic peptide (NT-proBNP) level, arrhythmias, and cardiovascular events (death, cardiac arrest, or cardiopulmonary resuscitation, rehospitalization due to heart failure or angina pectoris, deterioration of cardiac function, and stroke). Investigators and patients are both blinded to the allocated treatment. Discussion This prospective study will investigate the efficacy and safety of CDDP in improving ventricular remodeling and cardiac function in patients undergoing pPCI for a first AAMI. Patients in the CDDP group will be compared with those in the control group. If certified to be effective, CDDP treatment in AAMI will probably be advised on a larger scale. (Trial registration No. NCT05000411)