Trends in the Incidence of Vulvar and Vaginal Cancers With Different Histology by Race, Age, and Region in the United States (2001-2018).

Objectives: The race, age, and region-stratified incidence of vulvar (VUC) and vaginal (VAC) cancers with different histology were unclear. Methods: Data was retrieved from the United States Cancer Statistics database. Average annual percent change (AAPC) and incidence rate ratio (IRR) were calculated. Results: Overall, VUC incidence increased from 18.3 (per 1,000,000 woman-years) to 19.6, but VAC incidence decreased from 5.6 to 4.4. VUC squamous cell carcinoma (SCC) incidence increased (AAPC, 0.96; 95% CI, 0.66-1.25), VUC adenocarcinoma (ADE) incidence stabilized (AAPC, -0.24; 95% CI, -1.44 to 0.98), and VUC other malignancies (OM) incidence decreased (AAPC, -1.31; 95% CI, -2.58 to -0.02). While VAC incidence decreased for any histology (AAPC, -0.63; 95% CI, -1.03 to -0.22; AAPC, -1.60; 95% CI, -2.80 to -0.39; and AAPC, -1.57; 95% CI, -2.24 to -0.89 for SCC, ADE, and OM). Similar trends were observed in most of the stratifications. Conclusion: VUC and VAC incidences varied by histology overall and within stratifications by race, age, and region. The incidence decreased for VUC and VAC with all histologies, except for the increasing VUC SCC incidence.

Development and validation of models for predicting the overall survival and cancer-specific survival of patients with primary vaginal cancer: A population-based retrospective cohort study.

Background: No models have been developed to predict the survival probability for women with primary vaginal cancer (VC) due to VC's extreme rareness. We aimed to develop and validate models to predict the overall survival (OS) and cancer-specific survival (CSS) of VC patients. Methods: A population-based multicenter retrospective cohort study was carried out using the 2004-2018 Surveillance, Epidemiology, and End Results Program database in the United States. The final multivariate Cox model was identified using the Brier score and Harrell's C concordance statistic (C-statistic). The decision curve, calibration plot, and area under the time-dependent receiver operating characteristic curve (AUC) were used to evaluate model prediction performance. Multiple imputation followed by bootstrap was performed. Bootstrap validation covered the entire statistic procedure from model selection to baseline survival and coefficient calculation. Nomograms predicting OS and CSS were generated. Results: Of the 2,417 eligible patients, 1,692 and 725 were randomly allocated to the training and validation cohorts. The median age (Interquartile range) was 66 (56-78) and 65 (55-76) for the two cohorts, respectively. Our models had larger net benefits in predicting the survival of VC patients than the American Joint Committee on Cancer stage, presenting great discrimination ability and excellent agreement between the expected and observed events. The performance metrics of our models were calculated in three cohorts: the training cohort, complete cases of the validation cohort, and the imputed validation cohort. For the OS model in the three cohorts, the C-statistics were 0.761, 0.752, and 0.743. The slopes of the calibration plots were 1.017, 1.005, and 0.959. The 3- and 5-year AUCs were 0.795 and 0.810, 0.768 and 0.771, and 0.770 and 0.767, respectively. For the CSS model in the three cohorts, the C-statistics were 0.775, 0.758, and 0.755. The slopes were 1.021, 0.939, and 0.977. And the 3- and 5-year AUCs were 0.797 and 0.793, 0.786 and 0.788, and 0.757 and 0.757, respectively. Conclusion: We were the first to develop and validate exemplary survival prediction models for VC patients and generate corresponding nomograms that allow for individualized survival prediction and could assist clinicians in performing risk-adapted follow-up and treatment.

Hepatic Resection Is Associated With Improved Long-Term Survival Compared to Radio-Frequency Ablation in Patients With Multifocal Hepatocellular Carcinoma.

Background: The prognosis of patients with hepatocellular carcinoma (HCC) is of major public health interest. However, studies comparing hepatic resection (HR) and radio-frequency ablation (RFA) applied to multifocal HCC are limited. This study aimed to compare the efficacies of HR and RFA in patients with multifocal HCC. Methods: We retrospectively analyzed a cohort from the Surveillance, Epidemiology, and End Results database between 2004 and 2015. Disease-specific survival and overall survival rates were assessed before and after propensity score matching (PSM). Results: In total, 2,201 patients with multifocal HCC treated with HR (n = 1,095) or RFA (n = 1,106) were included; 1,096 patients were identified after nearest-neighbor PSM at a ratio of 1:1 (HR: n = 548; RFA: n = 548). In the multivariate Cox regression model, HR was associated with significantly improved disease-specific survival [before PSM: hazard ratio 0.67, 95% confidence interval (CI) 0.57-0.79, p < 0.001; after PSM: hazard ratio 0.69, 95% CI 0.58-0.82, p < 0.001] and overall survival (before PSM: hazard ratio 0.67, 95% CI 0.58-0.78, p < 0.001; after PSM: hazard ratio 0.69, 95% CI 0.59-0.80, p < 0.001) compared to RFA in patients with multifocal HCC. In the survival curve analysis, the disease-specific survival of the HR group was similar to that of the RFA group before PSM (p = 0.936, log-rank test) but was significantly longer after PSM (p < 0.001) in all patients. Multivariate analyses revealed that differentiation grade, alpha-fetoprotein, tumor size, and tumor extension were independent predictors of poor prognosis in patients with multifocal HCC. Conclusions: The long-term survival rate of HR is better than that of RFA in patients with multifocal HCC. HR may serve as a first-line treatment for patients with multifocal HCC. The presence of large tumors and vascular invasion are not contraindications for HR.

Radiotherapy Plus Chemotherapy Is Associated With Improved Survival Compared to Radiotherapy Alone in Patients With Primary Vaginal Carcinoma: A Retrospective SEER Study.

BACKGROUND: The efficacy of radiotherapy plus chemotherapy (RTCT) versus radiotherapy alone (RT) in the treatment of primary vaginal carcinoma has been controversial. We aimed to evaluate the up-to-date efficacy of RTCT on primary vaginal carcinoma in a real-world cohort. METHODS: We performed a retrospective analysis in patients with primary vaginal carcinoma retrieved from the Surveillance, Epidemiology, and End Results Program database from 2004 to 2016. Kaplan-Meier survival curves were plotted and compared by the log-rank test. Inverse probability weighting (IPW)-adjusted multivariate Cox proportional hazards and Fine-Gray competing-risk model was applied. RESULTS: Of the 1,813 qualified patients with primary vaginal carcinoma from 2004 to 2016, 1,137 underwent RTCT and 676 underwent RT. The median survival time was 34 months for the RT group and 63 months for the RTCT group. RTCT was significantly associated with improved overall survival (unadjusted HR = 0.71, 95% CI 0.62-0.82, p < 0.001; adjusted HR = 0.73, 95% CI 0.63-0.84, p < 0.001) and cancer-specific survival (unadjusted sHR = 0.81, 95% CI 0.69-0.95, p = 0.012; adjusted sHR = 0.81, 95% CI 0.69-0.96, p = 0.016). Age, histological type, tumor size, surgery, and FIGO stage were all independent prognostic factors for survival (p < 0.05 for all). Subgroup analysis demonstrated that RTCT was significantly associated with better survival in most subgroups, except for those with adenocarcinoma, tumor size <2 cm, or FIGO stage I. Moreover, sensitivity analysis did not alter the beneficial effects of RTCT. CONCLUSION: RTCT is significantly correlated with prolonged survival in patients with primary vaginal carcinoma. RTCT should be applied to most patients with primary vaginal carcinoma instead of RT alone, except for those with adenocarcinoma, tumor size <2 cm, or FIGO stage I.

[Effects of Phosphorus on the Activity and Bacterial Community in Mixotrophic Denitrification Sludge].

Biological denitrification is now one of the most widely applied techniques to remove nitrogen from the aquatic environment, and mixotrophic denitrification has gained attention as it takes the characteristics of both heterotrophic and autotrophic denitrification. This study investigated the biological denitrification efficiency and the bacterial community structure of sludge sampled from a mixotrophic denitrification reactor, before and after adding a certain amount of phosphate. The results showed that the bacteria have the capability of denitrification even without phosphorus, but the addition of phosphorus could significantly improve the biomass and the denitrification activity. After phosphate was added, the autotrophic and heterotrophic denitrification activity increased to 0.056 mg·(L·min·g)-1 and 0.232 mg·(L·min·g)-1 on N/VSS, which was 2.9 and 3.9 times that of the sludge activity before phosphorus addition, respectively. The bacterial community structure illustrated that the denitrifiers increased remarkably from 13.47% to 44.82% and that the dominate bacteria have also changed. Meanwhile, the growth of autotrophic, heterotrophic, and mixtrophic bacteria were all improved significantly after phosphorus was added.

Effects of hydraulic retention time and [Formula: see text] ratio on thiosulfate-driven autotrophic denitrification for nitrate removal from micro-polluted surface water.

This study was carried out to investigate the possibility of a thiosulfate-driven autotrophic denitrification for nitrate-N removal from micro-polluted surface water. The aim was to study the effects of [Formula: see text] ratio (S/N molar ratio) and hydraulic retention time (HRT) on the autotrophic denitrification performance. Besides, utilization efficiencies of [Formula: see text] along the biofilter and the restart-up of the bioreactor were also investigated. Autotrophic denitrification using thiosulfate as an electron donor for treating micro-polluted surface water without the addition of external alkalinity proved to be feasible and the biofilter could be readied in two weeks. Average nitrate-N removal efficiencies at HRTs of 0.5, 1 and 2 h were 78.7%, 87.8% and 97.4%, respectively, and corresponding removal rates were 186.24, 103.92 and 58.56 g [Formula: see text], respectively. When water temperature was in the range of 8-12°C and HRT was 1 h, average nitrate-N removal efficiencies of 41.9%, 97.1% and 97.0%, nitrite accumulation concentrations of 1.45, 0.46 and 0.22 mg/L and thiosulfate utilization efficiencies of 100%, 98.8% and 92.1% were obtained at S/N ratios of 1.0, 1.2 and 1.5, respectively. Besides, the autotrophic denitrification rate in the filtration media layer was the highest along the biofilter at an S/N ratio of 1.5. Finally, after a one-month period of starvation, the biofilter could be restarted successfully in three weeks without inoculation of seed sludge.

[Distribution of Different Mercury Species in the Waterbody at Sanmenxia Reservoir].

In order to obtain the distribution of different species of mercury (Hg) in the water in the Sanmenxia Reservoir, cold vapor atomic fluorescence spectrometry (CVAFS) and aqueous phase ethylation derivatization-gas chromatography-atomic fluorescence spectrometry (GC-CVAFS) methods were used for the analysis of total Hg (THg) and methylmercury (MeHg) in water and sediment samples, respectively. It was found that the levels of THg, dissolved mercury, and particulate mercury in the water ranged from 1.65-9.65, 0.80-3.16, and 0.70-7.81 ng·L-1, respectively. The THg in the water could meet the requirement for the Class I criterion in the national surface water environmental quality standard (GB 3838-2002). The amounts of MeHg, dissolved MeHg, and particulate MeHg in the water samples were 0.05-0.36, 0.02-0.14, and ND-0.26 ng·L-1, respectively. No evident seasonal or spatial patterns for Hg were observed. The THg and MeHg in the Sanmenxia Reservoir were within the ranges for those in uncontaminated waterbodies worldwide. The amount of THg in the sediments was (92.96±10.65) ng·g-1 and (80.06±19.14) ng·g-1, while the amount of MeHg in the corresponding sediment samples was (0.33±0.14) ng·g-1 and (0.50±0.19) ng·g-1 for wet and dry seasons, respectively. The ratios of MeHg/THg in the sediment of the Sanmenxia Reservoir were relatively small in comparison to those in other aqueous systems, indicating that methylation might play a minor role in the biogeochemistry of Hg in the Sanmenxia Reservoir. This might be attributed to the high dissolved oxygen levels of the bottom water and low organic carbon content of the sediments.

Mitral valve repair using an autologous pericardial strip in infants and young children.

We have modified the mitral repair technique in infants and small children by using autologous pericardial strips to treat mitral regurgitation resulting from a dilated mitral annulus. Our results demonstrate that this technique maintains stability and flexibility of the mitral annulus and decreases the risk of mitral stenosis.

Effects of HRT and water temperature on nitrogen removal in autotrophic gravel filter.

Organic Carbon added to low ratio of carbon to nitrogen (C/N ratio) wastewater to enhance heterotrophic denitrification performance might lead to higher operating costs and secondary pollution. In this study, sodium thiosulfate (Na2S2O3) was applied as an electron donor for a gravel filter (one kind of constructed wetland) to investigate effects of hydraulic retention time (HRT) and water temperature on the nitrate removal efficiency. The results show that with an HRT of 12 h, the average total nitrogen (TN) removal efficiencies were 91% at 15-20 °C and 18% at 3-6 °C, respectively. When HRT increased to 24 h, the average TN removal increased accordingly to 41% at 3-6 °C, suggesting denitrification performance was improved by extended HRT at low water temperatures. Due to denitrification, 96% of added nitrate nitrogen (NO3(-)-N) was converted to nitrogen gas, with a mean flux of nitrous oxide (N2O) was 0.0268-0.1500 ug m(-2) h(-1), while 98.86% of thiosulfate was gradually converted to sulfate throughout the system. Thus, our results show that the sulfur driven autotrophic denitrification constructed wetland demonstrated an excellent removal efficiency of nitrate for wastewater treatment. The HRT and water temperature proved to be two influencing factors in this constructed wetland treatment system.

[Study on the start-up of anaerobic ammonium oxidation process in biological activated carbon reactor].

In order to shorten the start-up time of anaerobic ammonium oxidation (ANAMMOX) reactor, biological activated cabon reactor was applied. Three lab scale UASB reactors were seeded with anaerobic sludge, fed with synthetic wastewater containing ammonia and nitrite, and supplemented with granular activated carbon on day 0, 33 and 56, respectively. The nitrogen removal performance of the first reactor, into which GAC was added on day 0, showed no significant improvement in 90 days. After being suspended for about one month, the secondary start-up of this reactor succeeded in another 33 days (totally 123 days). 49 d and 85 d were taken for the other two reactors started up by the addition of GAC on day 33 and 56, respectively. After the reactors were started up, the average removal rates of total nitrogen were 89.8%, 86.7% and 86.7%, respectively. The start-up process could be divided into four stages, namely, the bacterial autolysis phase, the lag phase, the improve phase and the stationary phase, and the best time for adding GAC carrier was right after the start of the lag phase.

[Study on sulfur-based autotrophic denitrification with different electron donors].

Sulphur-based autotrophic denitrification was applied to treat the low concentration nitrate-contaminated water. Different electron donors, namely, elemental sulfur, sulfide and thiosulfate, were used in three continuous reactors to compare the denitrification performance. When treating the low concentration nitrate-contaminated water (13 mg x L(-1)), the thiosulfate system showed the best performance and the sulfide system was the worst. The thiosulfate system was less sensitive to low temperature than the other two. At temperatures higher than 20 degrees C, the sulfur system was greatly influenced by mass transfer efficiency and HRT. It removed 81% of nitrate and 79% of TN when HRT was no less than 2 h, but could only achieve a low nitrate and TN removal rate of 47% and 51% when HRT was shorter than 2 h. No obvious nitrite accumulation was observed and the average effluent nitrite was 0.53 mg x L(-1). The sulfide system could only remove 47% of nitrate and 41% of TN with 0.29 mg x L(-1) nitrite in the effluent at the HRT of 4 h. Meanwhile, the thiosulfate system had a high removal rate of 99% for nitrate and 90% for TN, with a low content of effluent nitrite of 0.080 mg x L(-1), and the HRT could be shortened to 0.5 h. The molecular biological analysis showed that different bacteria predominated in the three reactors, and that Thiobacillus denitrificans existed abundantly in the sulfur system, while the functional bacteria in the sulfide and thiosulfate systems could not be identified yet. A new species of sulfur-based autotrophic denitrification bacterium may have been found.

[Start-up characteristics of the anaerobic reactor seeded with immobilized microorganisms].

In order to overcome the disadvantages of the anaerobic reactor such as slow growth and long start-up, the flocculent anaerobic sludge was embedded and used as the seed sludge in the anaerobic treatment of PTA wastewater with the objective of keeping biomass in the reactor. The start-up characteristics of the UASB reactor were investigated. During the 136 days' running, COD removal rate of PTA wastewater achieved 75%-85% at the volumetric loading rate (COD) of 3 kg x (m3 x d)(-1) and the hydraulic retention time (HRT) of 3-4 day. The anaerobic system had good stability and biomass retaining ability. On the other hand, variations of EPS, SEM observation and methanogens DNA in sludge granules verified the growth of immobilized bacteria in both quantity and microorganism morphology, although mass transfer through the immobilization media was to some degree limited.

[Effect of limited aeration on the thermophilic anaerobic treatment of high-sulfate refractory wastewater].

A thermophilic up-flow anaerobic sludge blanket (UASB) reactor was used to treat high-sulfate refractory wastewater from a sulfite pulp mill. The microorganisms were inhibited significantly as the result of sulfate reduction. Based on the consideration that the limited aeration may strip hydrogen sulfide out and oxidize part of the sulfide into nontoxic elemental sulfur, limited aeration was introduced into the reactor later to reduce the inhibition. The reactor showed much better running stability and higher treatment capacity thereafter. COD removal increased from 40%-50% to 60%-70% when the organic loading rate (OLR) was doubled. This study verified that some methanogens could be aerotolerant while some of the fermentation bacteria might be sensitive to the incomplete anaerobic surroundings.

[Air stripping-UASB process for the treatment of evaporator condensate from a Kraft pulp mill].

Evaporator condensate from a kraft pulp mill is characterized by high temperature, high strength, poor nutrition, and some odor and inhibitive materials. In this study, air stripping-UASB process was developed to treat the wastewater from a kraft pulp mill. The lab scale study demonstrated that air stripping process removed 70%-80% of the volatile organic sulfur compounds. After that, the UASB reactor showed high efficiency, at the organic loading rate (COD) of 30 kg x (m3 x d)(-1), COD removal was retained about 95%. On the other hand, the inoculated granules were broken in the new surroundings and were replaced with the newly formed granules The scanning electronic microscope (SEM) observation showed wide difference of the predominant anaerobic microorganisms in the seed and newly formed granules.