Displaying publications 1 - 20 of 42 in total

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  1. Hu T, Zheng Y, Zhang Y, Li G, Qiu W, Yu J, et al.
    BMC Microbiol, 2012;12:305.
    PMID: 23268691 DOI: 10.1186/1471-2180-12-305
    The identification of new virus strains is important for the study of infectious disease, but current (or existing) molecular biology methods are limited since the target sequence must be known to design genome-specific PCR primers. Thus, we developed a new method for the discovery of unknown viruses based on the cDNA--random amplified polymorphic DNA (cDNA-RAPD) technique. Getah virus, belonging to the family Togaviridae in the genus Alphavirus, is a mosquito-borne enveloped RNA virus that was identified using the Virus-Discovery-cDNA RAPD (VIDISCR) method.
  2. Mountjoy M, Akef N, Budgett R, Greinig S, Li G, Manikavasagam J, et al.
    Br J Sports Med, 2015 Jul;49(13):887-92.
    PMID: 25833900 DOI: 10.1136/bjsports-2014-094424
    Antidoping and medical care delivery programmes are required at all large international multisport events.
  3. Hu W, Yu XG, Wu S, Tan LP, Song MR, Abdulahi AY, et al.
    J Helminthol, 2016 Jul;90(4):392-7.
    PMID: 26123649 DOI: 10.1017/S0022149X15000413
    Ancylostoma ceylanicum is a common zoonotic nematode. Cats act as natural reservoirs of the hookworm and are involved in transmitting infection to humans, thus posing a potential risk to public health. The prevalence of feline A. ceylanicum in Guangzhou (South China) was surveyed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). In total, 112 faecal samples were examined; 34.8% (39/112) and 43.8% (49/112) samples were positive with hookworms by microscopy and PCR method, respectively. Among them, 40.8% of samples harboured A. ceylanicum. Twelve positive A. ceylanicum samples were selected randomly and used for cox 1 sequence analysis. Sequencing results revealed that they had 97-99% similarity with A. ceylanicum cox 1 gene sequences deposited in GenBank. A phylogenetic tree showed that A. ceylanicum isolates were divided into two groups: one comprising four isolates from Guangzhou (South China), and the other comprising those from Malaysia, Cambodia and Guangzhou. In the latter group, all A. ceylanicum isolates from Guangzhou were clustered into a minor group again. The results indicate that the high prevalence of A. ceylanicum in stray cats in South China poses a potential risk of hookworm transmission from pet cats to humans, and that A. ceylanicum may be a species complex worldwide.
  4. Li G, Pan P, He Q, Kong X, Wu K, Zhang W, et al.
    Virol Sin, 2017 Feb;32(1):63-72.
    PMID: 28120220 DOI: 10.1007/s12250-016-3872-8
    The dengue virus (DENV) is a vital global public health issue. The 2014 dengue epidemic in Guangzhou, China, caused approximately 40,000 cases of infection and five deaths. We carried out a comprehensive investigation aimed at identifying the transmission sources in this dengue epidemic. To analyze the phylogenetics of the 2014 dengue strains, the envelope (E) gene sequences from 17 viral strains isolated from 168 dengue patient serum samples were sequenced and a phylogenetic tree was reconstructed. All 17 strains were serotype I strains, including 8 genotype I and 9 genotype V strains. Additionally, 6 genotype I strains that were probably introduced to China from Thailand before 2009 were widely transmitted in the 2013 and 2014 epidemics, and they continued to circulate until 2015, with one affinis strain being found in Singapore. The other 2 genotype I strains were introduced from the Malaya Peninsula in 2014. The transmission source of the 9 genotype V strains was from Malaysia in 2014. DENVs of different serotypes and genotypes co-circulated in the 2014 dengue outbreak in Guangzhou. Moreover, not only had DENV been imported to Guangzhou, but it had also been gradually exported, as the viruses exhibited an enzootic transmission cycle in Guangzhou.
  5. Li G, Tang H, Chen Y, Yin Y, Ogawa S, Liu M, et al.
    Mol Cell Endocrinol, 2018 02 05;461:1-11.
    PMID: 28801227 DOI: 10.1016/j.mce.2017.08.003
    The LHb expression is up-regulated during puberty in female zebrafish. However, the molecular mechanism underlying how LHb expression is regulated during puberty remains largely unknown. In this study, we found that the mRNA expression levels of lhb, fshb and cyp19a1b were up-regulated along with the puberty onset in zebrafish. Among the three nuclear estrogen receptors (nERs), the esr2b is the only type whose expression is significantly up-regulated during puberty onset in the pituitary. However, in situ hybridization results revealed that lhb mRNA was colocalized with esr1 and esr2a but not esr2b. Exposure to estradiol (E2) significantly stimulates LHb expression in both wild-type and kiss1-/-;kiss2-/-;gnrh3-/- triple knockout pubertal zebrafish. Moreover, exposure of cultured pituitary cells to E2 increased the LHb expression, indicating that the estrogenic effect on LHb expression could be acted at the pituitary level. Finally, we cloned and analyzed the promoter of lhb by luciferase assay. Our results indicated that the E2 responsive regions of lhb promoter for ERα and ERβ2 are identical, suggesting that ERα and ERβ2 could bind to the same half ERE region of the promoter of lhb, exhibiting a classical ERE-dependent pathway. In summary, we demonstrate that E2 could directly act on the pituitary level to stimulate LHb transcription during puberty in zebrafish.
  6. She W, Qi T, Cui M, Yan P, Ng SW, Li W, et al.
    ACS Appl Mater Interfaces, 2018 May 02;10(17):14698-14707.
    PMID: 29638107 DOI: 10.1021/acsami.8b01187
    A family of two-dimensional salen-type lanthanide complexes was synthesized through a facile solution diffusion method. The two-dimensional lanthanide complexes were characterized by single-crystal X-ray diffraction (SCXRD) and X-ray photoelectron spectroscopy (XPS) analytical techniques. The SCXRD and XPS analyses reveal that the obtained two-dimensional structures are rich in uncoordinated imine (-CH═N-) groups located on the skeleton of the salen-type organic ligand, which retain strong coordination ability with metal ions. On the basis of this unique feature, a highly dispersed CeO2-supported Ni catalyst (Ni/CeO2-CAS) with highly strong metal-support interaction was first synthesized via a coordination-assisted synthesis (CAS) method, which exhibits a much better catalytic activity in the hydrogenation of nitrobenzene than the traditional Ni/CeO2-IWI catalyst prepared by incipient wetness impregnation (IWI). The origin of the improved catalytic activity of Ni/CeO2-CAS as well as the role of Ni@Ce-H2salen was revealed by using diverse characterizations. On the basis of the comparative characterization results, the superior catalytic performance of Ni/CeO2-CAS to Ni/CeO2-IWI could have resulted from the smaller and highly dispersed Ni nanoparticulates, the intensified Ni-CeO2 interaction, the enhanced NiO reducibility, and the higher concentration of oxygen vacancies, favoring the H2 dissociation and adsorption of the nitrobenzene reactant. The Ni/CeO2-CAS catalyst also exhibits high catalytic performance for reduction of diverse nitroarenes to their corresponding functionalized arylamines. We anticipated that this coordination-assisted strategy may provide a new way for preparing other highly oxide-supported catalysts with potential applications in various catalytic reactions.
  7. Yang T, Xiao Y, Zhang Z, Liang Y, Li G, Zhang M, et al.
    Sci Rep, 2018 09 28;8(1):14518.
    PMID: 30266999 DOI: 10.1038/s41598-018-32757-9
    Soft robots driven by stimuli-responsive materials have their own unique advantages over traditional rigid robots such as large actuation, light weight, good flexibility and biocompatibility. However, the large actuation of soft robots inherently co-exists with difficulty in control with high precision. This article presents a soft artificial muscle driven robot mimicking cuttlefish with a fully integrated on-board system including power supply and wireless communication system. Without any motors, the movements of the cuttlefish robot are solely actuated by dielectric elastomer which exhibits muscle-like properties including large deformation and high energy density. Reinforcement learning is used to optimize the control strategy of the cuttlefish robot instead of manual adjustment. From scratch, the swimming speed of the robot is enhanced by 91% with reinforcement learning, reaching to 21 mm/s (0.38 body length per second). The design principle behind the structure and the control of the robot can be potentially useful in guiding device designs for demanding applications such as flexible devices and soft robots.
  8. Safaei Khorram M, Zhang G, Fatemi A, Kiefer R, Maddah K, Baqar M, et al.
    J Sci Food Agric, 2019 Mar 15;99(4):1862-1869.
    PMID: 30264414 DOI: 10.1002/jsfa.9380
    BACKGROUND: Numerous studies have addressed the positive effects of organic amendments on soil and plant productivity under short-term field studies. However, to date, few studies have been conducted on the effects of organic amendment on the orchards where high nutrient bioavailability is required. This study deals with the effects of biochar and compost on soil quality, growth and yield of a replanted apple orchard in the northeast of Iran.

    RESULTS: Biochar+compost application resulted in 37% and 300% higher soil total organic carbon and available phosphorus content, respectively, during the first 3 years of experimentation compared to control. Similarly, trunk diameter and shoot number of apple trees increased 23-26% by the end of the first year. Nevertheless, there were no significant changes in fruitfulness, fruit weight or starch pattern index as productivity indices.

    CONCLUSION: Biochar and compost were beneficial in improving soil quality, mainly by increasing soil nutrient content and decreasing soil bulk density, and in increasing plant growth at early growth stages of apple orchards. However, they failed to enhance overall yield and fruit quality, most likely due to their limited ability to suppress apple replant disease. © 2018 Society of Chemical Industry.

  9. Mohd Sharif NA, Usman J, Wan Safwani WKZ, Siew Li G, Abdul Karim S, Mohamed NA, et al.
    Proc Inst Mech Eng H, 2019 Nov;233(11):1132-1140.
    PMID: 31597554 DOI: 10.1177/0954411919874614
    Knee sleeves are often prescribed to alleviate pain in people with early knee osteoarthritis. However, the biomechanics underlying their pain-relieving effect are still not well understood. This pre-post study aims at evaluating and comparing the effects of two different types of knee sleeves on knee adduction moment. Patients with clinically diagnosed knee osteoarthritis were recruited from the University of Malaya Medical Centre and were randomly assigned to two test groups using (1) a simple knee sleeve and (2) a simple sleeve with patella cutout. Knee adduction moment was collected using the Vicon motion capture system with two Kistler force plates. Pain, stiffness and physical functions were recorded using the Western Ontario and McMaster Universities Osteoarthritis Index. All measurements were taken before, immediately after and at the completion of 6 weeks of application (primary time point). In total, 17 participants with early unilateral knee osteoarthritis (47.7 (9.7) years) completed the study. Overall results show significant reduction in pain, early stance and late stance knee adduction moment and increased walking speed after 6 weeks of both knee sleeves application. This study results suggest that knee sleeves can reduce knee adduction moments in early unilateral knee osteoarthritis by 14.0% and 12.1% using the simple sleeve and the sleeve with patella cutout, respectively, and can potentially delay disease progression. In addition, knee sleeve with patella cutout does not provide additional benefits when compared to the simple knee sleeve.
  10. Gao Y, Zhang W, Liu C, Li G
    Sci Rep, 2019 12 11;9(1):18844.
    PMID: 31827114 DOI: 10.1038/s41598-019-54289-6
    Resistance to tamoxifen is a major clinical challenge. Research in recent years has identified epigenetic changes as mediated by dysregulated miRNAs that can possibly play a role in resistance to tamoxifen in breast cancer patients expressing estrogen receptor (ER). We report here elevated levels of EMT markers (vimentin and ZEB1/2) and reduced levels of EMT-regulating miR-200 (miR-200b and miR-200c) in ER-positive breast cancer cells, MCF-7, that were resistant to tamoxifen, in contrast with the naïve parental MCF-7 cells that were sensitive to tamoxifen. Further, we established regulation of c-MYB by miR-200 in our experimental model. C-MYB was up-regulated in tamoxifen resistant cells and its silencing significantly decreased resistance to tamoxifen and the EMT markers. Forced over-expression of miR-200b/c reduced c-MYB whereas reduced expression of miR-200b/c resulted in increased c-MYB We further confirmed the results in other ER-positive breast cancer cells T47D cells where forced over-expression of c-MYB resulted in induction of EMT and significantly increased resistance to tamoxifen. Thus, we identify a novel mechanism of tamoxifen resistance in breast tumor microenvironment that involves miR-200-MYB signaling.
  11. Li G, Li P, Chen Q, Thu HE, Hussain Z
    Curr Drug Deliv, 2019;16(2):94-110.
    PMID: 30360738 DOI: 10.2174/1567201815666181024142354
    BACKGROUND: Owing to their great promise in the spinal surgeries, bone graft substitutes have been widely investigated for their safety and clinical potential. By the current advances in the spinal surgery, an understanding of the precise biological mechanism of each bone graft substitute is mandatory for upholding the induction of solid spinal fusion.

    OBJECTIVE: The aim of the present review is to critically discuss various surgical implications and level of evidence of most commonly employed bone graft substitutes for spinal fusion.

    METHOD: Data was collected via electronic search using "PubMed", "SciFinder", "ScienceDirect", "Google Scholar", "Web of Science" and a library search for articles published in peer-reviewed journals, conferences, and e-books.

    RESULTS: Despite having exceptional inherent osteogenic, osteoinductive, and osteoconductive features, clinical acceptability of autografts (patient's own bone) is limited due to several perioperative and postoperative complications i.e., donor-site morbidities and limited graft supply. Alternatively, allografts (bone harvested from cadaver) have shown great promise in achieving acceptable bone fusion rate while alleviating the donor-site morbidities associated with implantation of autografts. As an adjuvant to allograft, demineralized bone matrix (DBM) has shown remarkable efficacy of bone fusion, when employed as graft extender or graft enhancer. Recent advances in recombinant technologies have made it possible to implant growth and differentiation factors (bone morphogenetic proteins) for spinal fusion.

    CONCLUSION: Selection of a particular bone grafting biotherapy can be rationalized based on the level of spine fusion, clinical experience and preference of orthopaedic surgeon, and prevalence of donor-site morbidities.

  12. Li G, Li P, Chen Q, Mani MP, Jaganathan SK
    PeerJ, 2019;7:e6986.
    PMID: 31179183 DOI: 10.7717/peerj.6986
    Traditionally, in the Asian continent, oils are a widely accepted choice for alleviating bone-related disorders. The design of scaffolds resembling the extracellular matrix (ECM) is of great significance in bone tissue engineering. In this study, a multicomponent polyurethane (PU), canola oil (CO) and neem oil (NO) scaffold was developed using the electrospinning technique. The fabricated nanofibers were subjected to various physicochemical and biological testing to validate its suitability for bone tissue engineering. Morphological analysis of the multicomponent scaffold showed a reduction in fiber diameter (PU/CO-853 ± 141.27 nm and PU/CO/NO-633 ± 137.54 nm) compared to PU (890 ± 116.911 nm). The existence of CO and NO in PU matrix was confirmed by an infrared spectrum (IR) with the formation of hydrogen bond. PU/CO displayed a mean contact angle of 108.7° ± 0.58 while the PU/CO/NO exhibited hydrophilic nature with an angle of 62.33° ± 2.52. The developed multicomponent also exhibited higher thermal stability and increased mechanical strength compared to the pristine PU. Atomic force microscopy (AFM) analysis depicted lower surface roughness for the nanocomposites (PU/CO-389 nm and PU/CO/NO-323 nm) than the pristine PU (576 nm). Blood compatibility investigation displayed the anticoagulant nature of the composites. Cytocompatibility studies revealed the non-toxic nature of the developed composites with human fibroblast cells (HDF) cells. The newly developed porous PU nanocomposite scaffold comprising CO and NO may serve as a potential candidate for bone tissue engineering.
  13. Safaei Khorram M, Zhang G, Fatemi A, Kiefer R, Mahmood A, Jafarnia S, et al.
    Environ Sci Pollut Res Int, 2020 May;27(15):18510-18520.
    PMID: 32198685 DOI: 10.1007/s11356-020-08335-w
    The introduction of biochar has been extensively tested under short-term greenhouse or field studies mainly in sandy or acidic soils, while its effects on soil properties, crop plants, and weed species especially in neutral or alkaline soils are still not well understood. Therefore, this study focused on relatively long effects of two walnut shell biochars (5 t ha-1) on soil nutrient dynamics, two crop plants (wheat and lentil) growth and developments, and weed growth dynamics over 4 years (2014-2017). Applied biochar added once at the beginning of the experiment while planted crops were supplied with macro-nutrients and sprayed with pesticides according to conventional requirements of the region. Biochars improved soil properties by 10-23% during the first and second years while positive effects of biochars on weed growth were drastically higher (60-78% higher weed density) during the whole period of this study most likely due to increase in bioavailability of nutrient shortly after biochar amendment and indirect positive effects of biochars on soil physical properties as well. Consequently, biochar macro- and micro-nutrient will be utilized by weed plants with higher efficacy compared with crop plants.
  14. Kujawski W, Li G, Van der Bruggen B, Pedišius N, Tonkonogij J, Tonkonogovas A, et al.
    Materials (Basel), 2020 Jun 25;13(12).
    PMID: 32630434 DOI: 10.3390/ma13122847
    Asymmetric polyphenylsulfone (PPSU) membranes were fabricated by a non-solvent induced phase inversion method. Glycerin and silica nanoparticles were added into the polymer solution to investigate their effects on the material properties and gas separation performance of prepared membranes. The morphology and structure of PPSU membranes were analyzed by scanning electron microscopy (SEM), the surface roughness of the selective layer was analyzed by atomic force microscopy (AFM), and the surface free energy was calculated based on the contact angle measurements by using various solvents. The gas separation performance of PPSU membranes was estimated by measuring the permeability of CO2 and CH4. The addition of glycerin as a nonsolvent into the polymer solution changed the cross-section structure from finger-like structure into sponge-like structure due to the delayed liquid-liquid demixing process, which was confirmed by SEM analysis. The incorporation of silica nanoparticles into PPSU membranes slightly increased the hydrophilicity, which was confirmed by water contact angle results. PPSU membrane fabricated from the polymer solution containing 10 wt.% glycerin showed the best CO2/CH4 selectivity of 3.86 and the CO2 permeability of 1044.01 Barrer. Mixed matrix PPSU membrane containing 0.1 wt.% silica nanoparticles showed the CO2/CH4 selectivity of 3.16 and the CO2 permeability of 1202.77 Barrer.
  15. Jiang H, Bai L, Ji L, Bai Z, Su J, Qin T, et al.
    J Virol, 2020 07 16;94(15).
    PMID: 32461319 DOI: 10.1128/JVI.00294-20
    Japanese encephalitis virus (JEV) infection alters microRNA (miRNA) expression in the central nervous system (CNS). However, the mechanism contributing to miRNA regulation in the CNS is not known. We discovered global degradation of mature miRNA in mouse brains and neuroblastoma (NA) cells after JEV infection. Integrative analysis of miRNAs and mRNAs suggested that several significantly downregulated miRNAs and their targeted mRNAs were clustered into an inflammation pathway. Transfection with miRNA 466d-3p (miR-466d-3p) decreased interleukin-1β (IL-1β) expression and inhibited JEV replication in NA cells. However, miR-466d-3p expression increased after JEV infection in the presence of cycloheximide, indicating that viral protein expression reduced miR-466d-3p expression. We generated all the JEV coding proteins and demonstrated NS3 helicase protein to be a potent miRNA suppressor. The NS3 proteins of Zika virus, West Nile virus, and dengue virus serotype 1 (DENV-1) and DENV-2 also decreased miR-466d-3p expression. Results from helicase-blocking assays and in vitro unwinding assays demonstrated that NS3 could unwind pre-miR-466d and induce miRNA dysfunction. Computational models and an RNA immunoprecipitation assay revealed arginine-rich domains of NS3 to be crucial for pre-miRNA binding and degradation of host miRNAs. Importantly, site-directed mutagenesis of conserved residues in NS3 revealed that R226G and R202W reduced the binding affinity and degradation of pre-miR-466d. These results expand the function of flavivirus helicases beyond unwinding duplex RNA to degrade pre-miRNAs. Hence, we revealed a new mechanism for NS3 in regulating miRNA pathways and promoting neuroinflammation.IMPORTANCE Host miRNAs have been reported to regulate JEV-induced inflammation in the CNS. We found that JEV infection could reduce expression of host miRNA. The helicase region of the NS3 protein bound specifically to miRNA precursors and could lead to incorrect unwinding of miRNA precursors, thereby reducing the expression of mature miRNAs. This observation led to two major findings. First, our results suggested that JEV NS3 protein induced miR-466d-3p degradation, which promoted IL-1β expression and JEV replication. Second, arginine molecules on NS3 were the main miRNA-binding sites, because we demonstrated that miRNA degradation was abolished if arginines at R226 and R202 were mutated. Our study provides new insights into the molecular mechanism of JEV and reveals several amino acid sites that could be mutated for a JEV vaccine.
  16. Chai WS, Sun D, Cheah KH, Li G, Meng H
    ACS Omega, 2020 Aug 11;5(31):19525-19532.
    PMID: 32803046 DOI: 10.1021/acsomega.0c01804
    Hydroxylammonium nitrate (HAN) is a promising green propellant because of its low toxicity, high volumetric specific impulse, and reduced development cost. Electrolytic decomposition of HAN is an efficient approach to prepare it for further ignition and combustion. This paper describes the investigation of a co-electrolysis effect on electrolytic decomposition of HAN-fuel mixtures using stainless steel-platinum (SS-Pt) electrodes. For the first time, different materials were utilized as electrodes to alter the cathodic reaction, which eliminated the inhibition effect and achieved a repeatable and consistent electrolytic decomposition of HAN solution. Urea and methanol were added as fuel components in the HAN-fuel mixtures. When the mass ratio of added urea ≥20%, the electrolytic decomposition of a HAN-urea ternary mixture achieved 67% increment in maximum gas temperature (Tgmax) and 185% increment in overall temperature increasing rate over the benchmark case of HAN solution. The co-electrolysis of urea released additional electrons into the mixtures and enhanced the overall electrolytic decomposition of HAN. In contrast, the addition of methanol did not improve the Tgmax but only increased the overall temperature increasing rate. This work has important implications in the development of an efficient and reliable electrolytic decomposition system of HAN and its mixtures for propulsion applications.
  17. Ma C, Lo PK, Xu J, Li M, Jiang Z, Li G, et al.
    Bioresour Technol, 2020 Oct;314:123731.
    PMID: 32615447 DOI: 10.1016/j.biortech.2020.123731
    In this study, the differences on the physico-chemical parameters, lignocellulose degradation, dynamic succession of microbial community, gene expression of carbohydrate-active enzymes and antibiotics resistance genes were compared during composting systems of bagasse pith/pig manure (BP) and manioc waste/pig manure (MW). The results revealed that biodegradation rates of organic matter, cellulose, hemicellulose and lignin (29.14%, 17.53%,45.36% and 36.48%) in BP were higher than those (15.59%, 16.74%, 41.23% and 29.77%) in MW. In addition, the relative abundance of Bacillus, Luteimonas, Clostridium, Pseudomonas, Streptomyces and expression of genes encoding carbohydrate- active enzymes in BP were higher than those in MW based on metagenomics sequencing. During composting, antibiotics and antibiotic resistance genes were substantially reduced, but the removal efficiency was divergent in the both samples. Taken together, metagenomics analysis was a potential method for evaluating lignocellulose's biodegradation process and determining the elimination of antibiotic and antibiotic resistance genes from different composting sources of biomass.
  18. Yang J, Qiu C, Li G, Lee WJ, Tan CP, Lai OM, et al.
    Food Chem, 2020 Oct 15;327:127014.
    PMID: 32434126 DOI: 10.1016/j.foodchem.2020.127014
    The influence of diacylglycerol (DAG) combined with polyglycerol polyricinoleate (PGPR) on the stability of water-in-oil (W/O) emulsions containing hydrogenated palm oil (HPO) was studied. Polarized light microscope revealed that DAG promoted HPO to crystallize at the water-oil interface, providing the combination of Pickering and network stabilization effects. It was proposed that the molecular compatibility of fatty acids in DAG with HPO accounted for the promotional effect. The interfacial crystallization of DAG together with the surface activity of PGPR led to the formation of emulsions with uniform small droplets and high freeze-thaw stability. Further exploration of physical properties indicated that the combination of DAG and PGPR dramatically improved the emulsion's viscoelasticity and obtained a larger deformation yield. Water droplets in DAG-based emulsions acted as active fillers to improve the network rigidity. Therefore, DAG is a promising material to be used as emulsifier to enhance the physical stability of W/O emulsions.
  19. Yang HK, Ji J, Han SU, Terashima M, Li G, Kim HH, et al.
    Lancet Gastroenterol Hepatol, 2021 02;6(2):120-127.
    PMID: 33253659 DOI: 10.1016/S2468-1253(20)30315-0
    BACKGROUND: Peritoneal recurrence of gastric cancer after curative surgical resection is common and portends a poor prognosis. Early studies suggest that extensive intraoperative peritoneal lavage (EIPL) might reduce the risk of peritoneal recurrence and improve survival. We aimed to evaluate the survival benefit of EIPL in patients with gastric cancer undergoing curative gastrectomy.

    METHODS: In this open-label, phase 3, multicentre randomised trial, patients aged 21-80 years with cT3 or cT4 gastric cancer undergoing curative resection were enrolled at 22 centres from South Korea, China, Japan, Malaysia, Hong Kong, and Singapore. Patients were randomly assigned to receive surgery and EIPL (EIPL group) or surgery alone (standard surgery group) via a web-based programme in random permuted blocks in varying block sizes of four and six, assuming equal allocation between treatment groups. Randomisation was stratified according to study site and the sequence was generated using a computer program and concealed until the interventions were assigned. After surgery in the EIPL group, peritoneal lavage was done with 1 L of warm (42°C) normal 0·9% saline followed by complete aspiration; this procedure was repeated ten times. The primary endpoint was overall survival. All analyses were done assuming intention to treat. This trial is registered with ClinicalTrials.gov, NCT02140034.

    FINDINGS: Between Sept 16, 2012, and Aug 3, 2018, 800 patients were randomly assigned to the EIPL group (n=398) or the standard surgery group (n=402). Two patients in the EIPL group and one in the standard surgery group withdrew from the trial immediately after randomisation and were excluded from the intention-to-treat analysis. At the third interim analysis on Aug 28, 2019, the predictive probability of overall survival being significantly higher in the EIPL group was less than 0·5%; therefore, the trial was terminated on the basis of futility. With a median follow-up of 2·4 years (IQR 1·5-3·0), the two groups were similar in terms of overall survival (hazard ratio 1·09 [95% CI 0·78-1·52; p=0·62). 3-year overall survival was 77·0% (95% CI 71·4-81·6) for the EIPL group and 76·7% (71·0-81·5) for the standard surgery group. 60 adverse events were reported in the EIPL group and 41 were reported in the standard surgery group. The most common adverse events included anastomotic leak (ten [3%] of 346 patients in the EIPL group vs six [2%] of 362 patients in the standard surgery group), bleeding (six [2%] vs six [2%]), intra-abdominal abscess (four [1%] vs five [1%]), superficial wound infection (seven [2%] vs one [<1%]), and abnormal liver function (six [2%] vs one [<1%]). Ten of the reported adverse events (eight in the EIPL group and two in the standard surgery group) resulted in death.

    INTERPRETATION: EIPL and surgery did not have a survival benefit compared with surgery alone and is not recommended for patients undergoing curative gastrectomy for gastric cancer.

    FUNDING: National Medical Research Council, Singapore.

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