Clinical application of transoral and submental thyroidectomy (TOaST): a series of 54 human cases.

OBJECTIVE: A new endoscopic thyroidectomy approach-transoral and submental endoscopic thyroidectomy (TOaST)-was applied in clinical practice and considered an improved approach for endoscopic thyroid surgery via the oral approach. This paper discusses the feasibility and effectiveness of this surgical method. METHODS: A retrospective analysis was performed on the clinical data of 54 patients who had undergone TOaST in the thyroid disease center of the First Affiliated Hospital of Nanchang University between December 2020 and December 2021. The surgical data and techniques, complications, and cosmetic outcomes of these patients were studied. RESULTS: Among the total 54 patients, 23 underwent unilateral subtotal thyroidectomy, 3 patients underwent bilateral subtotal thyroidectomy, 27 with unilateral thyroid cancer underwent affected thyroid + isthmus + central lymph node resection, and only 1 patient underwent total thyroidectomy. The mean operative time was 88.06 ± 12.03 min (range: 65-135 min), the mean intraoperative blood loss was 8.61 ± 4.60 ml (range: 5-20 ml), the mean postoperative drainage volume was 49.96 ± 9.88 ml (range: 30-60 ml), the mean drainage time was 36.61 ± 2.65 h (range: 32-50 h), and the mean length of hospital stay was 46.63 ± 3.28 h (range 45-70 h). One patient experienced transient recurrent laryngeal nerve injury, and another patient experienced transient parathyroid dysfunction; there was no superior laryngeal nerve injury and other complications, such as postoperative subcutaneous hematoma, hypercapnia, mental nerve injury, tracheoesophageal injury, infection, or lymphatic leakage. CONCLUSION: TOaST cannot only achieve a good therapeutic effect but also avoid mental nerve injury, reduce the discomfort of the patient's jaw, obtain a good cosmetic effect, and facilitate the operation of the operator. It is an endoscopic thyroidectomy technique with a certain clinical value.

PEG-L-CHOP treatment is safe and effective in adult extranodal NK/T-cell lymphoma with a low rate of clinical hypersensitivity.

BACKGROUND: The combination of chemotherapy and L-asparaginase (L-ASP) treatment significantly increased survival rate in an adult patient with extranodal natural killer (NK)/T-cell lymphoma (NKTCL). However, hypersensitivity reactions of L-ASP in some patients limited its application. Polyethylene glycol-conjugated asparaginase (PEG-ASP) has a lower immunogenicity and longer circulating half-life than unconjugated L-ASP, and has been reported to be effective and well-tolerated in children with acute lymphoblastic leukemia. Cyclophosphamide, hydroxydaunorubicin (doxorubicin), oncovin (vincristine), and prednisolone (CHOP) is the most common chemotherapy for non-Hodgkin lymphoma. In this report, we sought to study the efficacy and safety of PEG-L- CHOP in NKTCL in adult Chinese patients. METHODS: Our study is a prospective, multi-center, open-label clinical trial. Patients with newly diagnosed adult NKTCL and an ECOG performance status of 0 to 2 were eligible for enrollment. Treatment included six cycles of PEG-L-CHOP regimen. Radiotherapy was scheduled after 2-4 cycles of PEG-L-CHOP regimen, depending on the stage and primary anatomic site. RESULTS: We enrolled a total of 33 eligible patients. All 33 patients completed 170 cycles of chemotherapy combined with radical radiotherapy. The overall response rate was 96.9% (32/33) with 75.8% (25/33) achieving complete responses and 21.2% (7/33) achieving partial responses. The overall survival (OS) at 1, 2, 3-year were 100, 90.61 and 80.54%, respectively. The major adverse effects were bone marrow suppression, reduction of fibrinogen level, liver dysfunction, and digestive tract toxicities. No allergic reaction and no treatment-related mortality or severe complications were recorded. CONCLUSIONS: PEG-L-CHOP chemotherapy in combination radiotherapy is safe and durably effective treatment for adult extranodal NK/T-cell lymphoma with fewer allergic reactions. This study was approved by the Peking University Beijing Cancer Hospital Ethics Review Committee (reference number: 2011101104). The clinical trial registration number ChiCTR1800016940 was registered on July 07, 2018 at the Chinese Clinical Trial Registry ( http://www.chictr.org.cn/index.aspx ). The clinical trial was registered retrospectively.

Safety and efficacy of bevacizumab combined with R-CHOP regimen in seven Chinese patients with untreated diffuse large B-cell lymphoma.

BACKGROUND: Rituximab plus CHOP (R-CHOP) significantly improved the outcome of diffuse large B cell lymphoma (DLBCL), a common sub-type of non-Hodgkin lymphoma. But 40% - 50% of DLBCL patients cannot be cured by this regimen. Some clinical trials showed that bevacizumab might be useful in the treatment of DLBCL. This study evaluated the safety and efficacy of bevacizumab combined with the R-CHOP (A-R-CHOP) regimen in Chinese patients with previously untreated DLBCL. METHODS: Patients with previously untreated DLBCL received A-R-CHOP regimen therapy. All patients with complete response (CR)/ unconfirmed complete response(CRu) after 8 cycles of A-R-CHOP received the bevacizumab maintenance therapy once every 3 weeks. The remained bulky disease was treated with radiotherapy. RESULTS: Seven Chinese patients were treated. All of them had bulky diseases. One patient had progressive disease after 4 cycles of A-R-CHOP therapy. The rest six patients completed 8 cycles of A-R-CHOP treatment. All of these six patients reached CR/CRu (5 CR, 1 CRu). Bevacizumab maintenance therapy was given to 4 CR patients. All 7 patients experienced Grade 3/4 hematologic adverse events; additionally, one had Grade 3 gastrointestinal toxicity and one had Grade 1 epistaxis. During bevacizumab maintenance therapy, one patient had Grade 1 gingival bleeding, another experienced Grade 1 proteinuria and then Grade 3 congestive heart failure 4 months after completion of maintenance therapy. At the end of July 2013, the patient who had progressive disease after 4 cycles of A-R-CHOP died of progressive disease, the other six remained CR response. CONCLUSIONS: The A-R-CHOP regimen is effective for untreated DLBCL, but may cause bevacizumab-specific toxicities, which should be monitored.

The Advantages of Applying a 5-mm Endoscope in the Transoral Endoscopic Thyroidectomy Vestibular Approach.

OBJECTIVE: We sought to compare the effect of applying a 5-mm endoscope and a 10-mm endoscope in the transoral endoscopic thyroidectomy vestibular approach (TOETVA) and to clarify the advantages of using a 5-mm endoscope. MATERIALS AND METHODS: A retrospective analysis of the clinical data of 135 patients who were diagnosed with papillary thyroid carcinoma and who had undergone TOETVA in the thyroid disease center of The First Affiliated Hospital of Nanchang University between January 2019 and May 2020 was performed. Among the included patients, a 10-mm endoscope was used in 50 cases (the 10-mm endoscope group) and a 5-mm endoscope was used in 85 cases (the 5-mm endoscope group), respectively. Operative trauma, operative parameters, postoperative complications, and postoperative mandibular sensation score were compared and analyzed. RESULTS: Compared with the 10-mm endoscope group, the 5-mm endoscope group had less surgical trauma, less injury to the mandibular muscles (orbicularis oris, depressor labii inferioris, and mentalis muscle), shorter operative times (107.7±8.1 vs. 121.3±11.6 min, P<0.01), less intraoperative bleeding (14.3±4.8 vs. 17.9±5.3 mL, P<0.01), no obvious postoperative complications, lower mandibular sensation score values (5.7±0.6 vs. 6.0±0.4 points, P<0.01), and shorter mandibular recovery times (9.4±2.5 vs. 12.3±3.6 d, P<0.01). CONCLUSION: The application of a 5-mm endoscope not only improves the cosmetic effect of TOETVA but also reduces the degree of surgical trauma, saves the surgical space, improves the surgical efficiency, and reduces postoperative discomfort, with a promising application prospect.

Recent advances in attached growth membrane bioreactor systems for wastewater treatment.

To tackle membrane fouling and limited removals of pollutants (nutrients and emerging pollutants) that hinder the wide applications of membrane bioreactor (MBR), attached growth MBR (AGMBR) combining MBR and attached growth process has been developed. This review comprehensively presents the up-to-date developments of media used in both aerobic and anaerobic AGMBRs for treating wastewaters containing conventional and emerging pollutants. It also elaborates the properties of different media, characteristics of attached biomass, and their contributions to AGMBR performance. Conventional media, such as biological activated carbon and polymeric carriers, induce formation of aerobic, anoxic and/or anaerobic microenvironment, increase specific surface area or porous space for biomass retention, improve microbial activities, and enrich diverse microorganisms, thereby enhancing pollutants removal. Meanwhile, new media (i.e. biochar, bioaugmented carriers with selected strain/mixed cultures) do not only eliminate conventional pollutants (i.e. high concentration of nitrogen, etc.), but also effectively remove emerging pollutants (i.e. micropollutants, nonylphenol, adsorbable organic halogens, etc.) by forming thick and dense biofilm, creating anoxic/anaerobic microenvironments inside the media, enriching special functional microorganisms and increasing activity of microorganisms. Additionally, media can improve sludge characteristics (i.e. less extracellular polymeric substances and soluble microbial products, larger floc size, better sludge settleability, etc.), alleviating membrane fouling. Future studies need to focus on the development and applications of more new functional media in removing wider spectrum of emerging pollutants and enhancing biogas generation, as well as scale-up of lab-scale AGMBRs to pilot or full-scale AGMBRs.

Application of a specific membrane fouling control enhancer in membrane bioreactor for real municipal wastewater treatment: Sludge characteristics and microbial community.

The feasibility of a novel bioflocculant (GemFloc™) for membrane fouling mitigation in membrane bioreactor (MBR) was investigated during real municipal wastewater treatment. When compared to the conventional MBR (CMBR), suspended sludge in the MBR with GemFloc™ (G-MBR) showed less soluble microbial products (SMP), higher ratios of proteins to polysaccharides in SMP (SMPP/SMPC) and loosely bound extracellular polymeric substances (LB-EPS). Adding GemFloc™ also enlarged floc size (> 200 µm), and increased tightly bound EPS levels, zeta potential and relative hydrophobicity of sludge flocs, further reduced cake layer and pore blocking resistances. Moreover, more diverse microbial community and enrichment of fouling reduction microbes such as Arenimonas and Flavihumibacter were observed in the G-MBR, together with less abundant microbes (e.g. Sphaerotilus and Povalibacter) which could aggravate membrane fouling. Therefore, GemFloc™ has high capability in improving sludge characteristics, mitigating membrane fouling and increasing diversity of special functional bacterial community in MBR.

Pre-coagulation coupled with sponge-membrane filtration for organic matter removal and membrane fouling control during drinking water treatment.

A new hybrid system was developed in this study for the treatment of drinking water consisting of pre-coagulation using polyaluminium chloride (PACl) and membrane filtration (MF) with sponge cubes acting as biomass carriers (P-SMF). When compared to a conventional MF (CMF) and a MF after coagulation by utilizing PACl (P-MF), better removal of nutrients, UV254 and dissolved organic carbon (DOC) (>65%) was obtained from the P-SMF. The accumulation of biopolymers (including polysaccharides and proteins), humic substances, hydrophilic organics, and other small molecular weight (MW) organic matter in the CMF led to the most severe membrane fouling coupled with the highest pore blocking and cake resistance. Pre-coagulation was ineffective in eliminating small MW and hydrophilic organic matter. Conversely, the larger MW organics (i.e. biopolymers and humic substances), small MW organics and hydrophilic organic compounds could be removed in significantly larger quantities in the P-SMF by PACl coagulation. This was achieved via adsorption and the biodegradation by attached biomass on these sponges and by the suspended sludge. Further analyses of the microbial community indicated that the combined addition of PACl and sponges generated a high enrichment of Zoolgloea, Amaricoccus and Reyranella leading to the reduction of biopolymers, and Flexibacter and Sphingobium were linked to the degradation of humic substances. Moreover, some members of Alphaproteobacteria in the P-SMF may be responsible for the removal of low MW organics. These results suggest that the pre-coagulation process coupled with adding sponge in the MF system is a promising technology for mitigating membrane fouling.

Specific approach for membrane fouling control and better treatment performance of an anaerobic submerged membrane bioreactor.

This paper investigated a strategy to minimize membrane fouling and increase treatment efficiency through an investigation of a specific approach by adding sponges into a conventional submerged anaerobic membrane bioreactor (CAnSMBR). During the operation, the protein-based soluble microbial products as the main factor affecting the membrane fouling could be reduced by sponge addition in the CAnSMBR (SAnSMBR). Furthermore, reducing HRT from 18 h to 12 h could shorten the membrane fouling cycle to 62% and 87% in CAnSMBR and SAnSMBR, respectively. At the initial of COD/NO3 ratio ranges from 5 to 4, only 88% of nitrogen in CAnSMBR was removed, while the SAnSMBR could remove more than 90%. TOC removal efficiency could reach more than 95% under a good stirring scenario. It is evident that the SAnSMBR is a promising solution for improving overall CAnSMBR performance and substantially mitigating membrane fouling.

Effect of hydraulic retention time on the performance of a hybrid moving bed biofilm reactor-membrane bioreactor system for micropollutants removal from municipal wastewater.

This study evaluated micropollutants removal and membrane fouling behaviour of a hybrid moving bed biofilm reactor-membrane bioreactor (MBBR-MBR) system at four different hydraulic retention times (HRTs) (24, 18, 12 and 6h). The results revealed that HRT of 18h was the optimal condition regarding the removal of most selected micropollutants. As the primary removal mechanism in the hybrid system was biodegradation, the attached growth pattern was desirable for enriching slow growing bacteria and developing a diversity of biocoenosis. Thus, the efficient removal of micropollutants was obtained. In terms of membrane fouling propensity analysis, a longer HRT (e.g. HRTs of 24 and 18h) could significantly mitigate membrane fouling when compared with the shortest HRT of 6h. Hence, enhanced system performance could be achieved when the MBBR-MBR system was operated at HRT of 18h.

New functional biocarriers for enhancing the performance of a hybrid moving bed biofilm reactor-membrane bioreactor system.

In this study, new sponge modified plastic carriers for moving bed biofilm reactor (MBBR) was developed. The performance and membrane fouling behavior of a hybrid MBBR-membrane bioreactor (MBBR-MBR) system were also evaluated. Comparing to the MBBR with plastic carriers (MBBR), the MBBR with sponge modified biocarriers (S-MBBR) showed better effluent quality and enhanced nutrient removal at HRTs of 12h and 6h. Regarding fouling issue of the hybrid systems, soluble microbial products (SMP) of the MBR unit greatly influenced membrane fouling. The sponge modified biocarriers could lower the levels of SMP in mixed liquor and extracellular polymeric substances in activated sludge, thereby mitigating cake layer and pore blocking resistances of the membrane. The reduced SMP and biopolymer clusters in membrane cake layer were also observed. The results demonstrated that the sponge modified biocarriers were capable of improving overall MBBR performance and substantially alleviated membrane fouling of the subsequent MBR unit.

Biofouling and control approaches in membrane bioreactors.

Membrane fouling (especially biofouling) as a critical issue during membrane reactor (MBR) operation has attracted much attention in recent years. Although previous review papers have presented different aspects of MBR's fouling when treating various wastewaters, the information related to biofouling in MBRs has only simply or partially reviewed. This work attempts to give a more comprehensive and elaborate explanation of biofilm formation, biofouling factors and control approaches by addressing current achievements. This also suggests to a better way in controlling biofouling by developing new integrated MBR systems, novel flocculants and biomass carriers.

One-pot solventless preparation of PEGylated black phosphorus nanoparticles for photoacoustic imaging and photothermal therapy of cancer.

Black phosphorus (BP) nanostructures such as nanosheets and nanoparticles have attracted considerable attention in recent years due to their unique properties and great potential in various physical, chemical, and biological fields. In this article, water-soluble and biocompatible PEGylated BP nanoparticles with a high yield were prepared by one-pot solventless high energy mechanical milling technique. The resultant BP nanoparticles can efficiently convert near infrared (NIR) light into heat, and exhibit excellent photostability, which makes them suitable as a novel nanotheranostic agent for photoacoustic (PA) imaging and photothermal therapy of cancer. The in-vitro results demonstrate the excellent biocompatibility of PEGylated BP nanoparticles, which can be used for photothermal ablation of cancer cells under irradiation with NIR light. The in-vivo PA images demonstrate that these BP nanoparticles can be efficiently accumulated in tumors through the enhanced permeability retention effect. The resultant BP nanoparticles can be further utilized for photothermal ablation of tumors by irradiation with NIR light. The tumor-bearing mice were completely recovered after photothermal treatment with BP nanoparticles, in comparison with mice from control groups. Our research highlights the great potential of PEGylated BP nanoparticles in detection and treatment of cancer.

Effects of hydraulic retention time and bioflocculant addition on membrane fouling in a sponge-submerged membrane bioreactor.

The characteristics of activated sludge and membrane fouling were evaluated in a sponge-submerged membrane bioreactor (SSMBR) at different hydraulic retention times (HRTs) (6.67, 5.33 and 4.00h). At shorter HRT, more obvious membrane fouling was caused by exacerbated cake layer formation and aggravated pore blocking. Activated sludge possessed more extracellular polymeric substances (EPS) due to excessive growth of biomass and lower protein to polysaccharide ratio in soluble microbial products (SMP). The cake layer resistance was aggravated by increased sludge viscosity together with the accumulated EPS and biopolymer clusters (BPC) on membrane surface. However, SMP showed marginal effect on membrane fouling when SSMBRs were operated at all HRTs. The SSMBR with Gemfloc® addition at the optimum HRT of 6.67h demonstrated superior sludge characteristics such as larger floc size, less SMP in mixed liquor with higher protein/polysaccharide ratio, less SMP and BPC in cake layer, thereby further preventing membrane fouling.

A comparison study on membrane fouling in a sponge-submerged membrane bioreactor and a conventional membrane bioreactor.

This study compared membrane fouling in a sponge-submerged membrane bioreactor (SSMBR) and a conventional membrane bioreactor (CMBR) based on sludge properties when treating synthetic domestic wastewater. In the CMBR, soluble microbial products (SMP) in activated sludge were a major contributor for initial membrane fouling and presented higher concentration in membrane cake layer. Afterwards, membrane fouling was mainly governed by bound extracellular polymeric substances (EPS) in activated sludge, containing lower proteins but significantly higher polysaccharides. Sponge addition could prevent cake formation on membrane surface and pore blocking inside membrane, thereby alleviating membrane fouling. The SSMBR exhibited not only less growth of the biomass and filamentous bacteria, but also lower cake layer and pore blocking resistance due to lower bound EPS concentrations in activated sludge. Less membrane fouling in SSMBR were also attributed to larger particle size, higher zeta potential and relative hydrophobicity of sludge flocs.