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.

One-stage freehand minimally invasive pedicle screw fixation combined with mini-access surgery through OLIF approach for the treatment of lumbar tuberculosis.

OBJECTIVE: To compare one-stage freehand minimally invasive pedicle screw fixation (freehand MIPS) combined with mini-access surgery through OLIF approach with posterior approach for treatment of lumbar tuberculosis (TB), and evaluate its feasibility, efficacy and safety in debridement, bone graft fusion and internal fixation. METHODS: 48 patients with single segment lumbar TB from June 2014 to June 2017 were included. Among them, 22 patients underwent one-stage freehand MIPS combined with mini-access surgery through OLIF approach (group 1), 26 patients were treated with posterior open surgery (group 2). Duration of operation, blood loss, and stay time in hospital were compared. Pre- and postoperative visual analog scale (VAS) pain scores, Oswestry disability index (ODI), erythrocyte sedimentation rate, complications and images were also recorded. RESULTS: Patients in group 1 showed significantly less blood loss (165 ± 73 ml vs 873 ± 318 ml, P < 0.001), shorter stay time in hospital (6/4-8 days vs 12/8-15 days, P < 0.001), while longer duration of operation (185 ± 14 min vs 171 ± 12 min, P < 0.001) than group 2 did. VAS scores significantly decreased after surgery in both groups, however, VAS scores of group 1 were significantly lower than that of group 2 immediately after surgery and during follow-ups (P < 0.001). ODI of group 1 was also significantly lower than that of group 2 at 12-month after surgery (P < 0.001). CONCLUSION: One-stage freehand MIPS combined with mini-access surgery through OLIF approach is a feasible, efficient and safe method in treating single segment lumbar TB. It shows advantages of less surgical trauma and faster postoperative recovery.

Efficacy and safety of anterior cervical discectomy and fusion (ACDF) through mini-incision and posterior laminoplasty (LAMP) for treatment of long-level cervical spondylosis: a retrospective cohort study.

BACKGROUND: The efficacy and safety of anterior cervical discectomy and fusion (ACDF) through mini-incision and posterior laminoplasty for long-level cervical spondylosis were investigated. METHOD: From January 2018 to September 2019, clinical patients data with 3-4 segments (C3-7) cervical spondylotic radiculopathy, cervical spondylotic myelopathy, or mixed cervical spondylosis who received ACDF (42 cases) throughwith mini-incision or LAMP (36 cases) treatment were retrospectively collected and analyzed. The operative time, bleeding volume, incisive length, and hospital stay were recorded. Moreover, the intervertebral height, functional segment height, cervical lordosis, cervical hyperextension and hyperflexion range-of-motion (ROM) and ROM in all directions of the cervical spine before and after the operation were measured. Additionally, all relevant postoperative complications were also recorded. Then, the therapeutic effects of both surgical methods were investigated. RESULTS: Patients in the ACDF group had less bleeding, shorter incision, and fewer hospitalization days than the LAMP group. There was no significant difference in JOA, VAS score of the upper limb, NDI score after surgery between two groups. Postoperative intervertebral height and functional segment height in the ACDF group were significantly higher than those before the operation, and postoperative functional segment height of the ACDF group was significantly higher than that of the LAMP group. Moreover, the postoperative cervical lordosis angle in the ACDF group was significantly larger than the LAMP group. There was no significant difference between preoperative and postoperative ROM in all directions of the cervical spine for the two groups. CONCLUSIONS: Both ACDF through mini-incision and LAMP are effective treatments for long-level cervical spondylosis. However, ACDF through mini-incision shows minor trauma, less bleeding, fast recovery, and it is beneficial for cervical lordosis reconstruction.

miR-185-5p Represses Cells Growth and Metastasis of Osteosarcoma via Targeting Cathepsin E.

Osteosarcoma (OS) is a malignant bone tumor characterized by poor prognosis due to its regional invasion and early metastasis. In this study, we aimed to find the role and the underlying mechanism of Cathepsin E (CTSE) in OS growth and metastasis. We found CTSE is upregulated in metastatic OS, rather than in the primary lesion, as confirmed by RT-qPCR and western blot analysis of clinical OS samples. Furthermore, both in vitro and in vivo experiments illustrated that CTSE promoted both growth and metastasis of OS cells, partially mediated through the modulation of Epithelial-Mesenchymal Transition (EMT). Bioinformatics analysis predicted that miR-185-5p downregulates CTSE via directly binding to the 3'UTR of CTSE, which was verified by luciferase reporter assay and rescue assays. This study reported for the first time that CTSE is a potential biomarker in OS tumorigenesis and metastasis, providing a promising therapeutic target for OS treatment.

Acacetin inhibits invasion, migration and TGF-ß1-induced EMT of gastric cancer cells through the PI3K/Akt/Snail pathway.

BACKGROUND: Epithelial-to-mesenchymal transition (EMT) is a pivotal cellular phenomenon involved in tumour metastasis and progression. In gastric cancer (GC), EMT is the main reason for recurrence and metastasis in postoperative patients. Acacetin exhibits various biological activities. However, the inhibitory effect of acacetin on EMT in GC is still unknown. Herein, we explored the possible mechanism of acacetin on EMT in GC in vitro and in vivo. METHODS: In vitro, MKN45 and MGC803 cells were treated with acacetin, after which cell viability was detected by CCK-8 assays, cell migration and invasion were detected by using Transwell and wound healing assays, and protein expression was analysed by western blots and immunofluorescence staining. In vivo, a peritoneal metastasis model of MKN45 GC cells was used to investigate the effects of acacetin. RESULTS: Acacetin inhibited the proliferation, invasion and migration of MKN45 and MGC803 human GC cells by regulating the expression of EMT-related proteins. In TGF-ß1-induced EMT models, acacetin reversed the morphological changes from epithelial to mesenchymal cells, and invasion and migration were limited by regulating EMT. In addition, acacetin suppressed the activation of PI3K/Akt signalling and decreased the phosphorylation levels of TGF-ß1-treated GC cells. The in vivo experiments demonstrated that acacetin delayed the development of peritoneal metastasis of GC in nude mice. Liver metastasis was restricted by altering the expression of EMT-related proteins. CONCLUSION: Our study showed that the invasion, metastasis and TGF-ß1-induced EMT of GC are inhibited by acacetin, and the mechanism may involve the suppression of the PI3K/Akt/Snail signalling pathway. Therefore, acacetin is a potential therapeutic reagent for the treatment of GC patients with recurrence and metastasis.

Developing and Validating Novel Nomograms for Predicting the Overall Survival and Cancer-Specific Survival of Patients With Primary Vulvar Squamous Cell Cancer.

Background: To develop and validate novel nomograms for better predicting the overall survival (OS) and cancer-specific survival (CSS) of patients with vulvar squamous cell cancer (VSCC). Methods: A retrospective analysis using a population-based database between 2004 and 2016 was carried. A 10-fold cross-validation with 200 repetitions was used to choose the best fit multivariate Cox model based on the net-benefit of decision curve analysis. Net-benefit, Harrell's C concordance statistic (C-statistic) of calibration plot, and area under the receiver operating characteristic curve (AUC) were used to evaluate the model prediction accuracy. Nomograms of the OS and CSS were generated based on the best fit model. Results: Of the 6,792 patients with VSCC, 5,094 (75%) and 1,698 (25%) were allocated to the training and validation cohort, respectively. All the variables were balanced between the training and validation cohorts. Age, insurance, tumor size, pathological grade, radiotherapy, chemotherapy, invasion depth, lymphadenectomy, sentinel lymph nodes biopsy, surgery, N stage, and M stage were in the best fit model for generating nomograms. The decision curve analysis, calibration plot, and receiver operating characteristic (ROC) curve show the better prediction performance of the model compared to previous studies. The C-statistics of our model for OS prediction are 0.80, 0.83, and 0.81 in the training, validation, and overall cohorts, respectively, while for CSS prediction are 0.83, 0.85, and 0.84. The AUCs for 3- and 5-year OS are the same and are 0.81, 0.83, and 0.81 in the training, validation, and overall cohorts, respectively. The AUCs for 3- and 5-year CSS are 0.78 and 0.80, 0.79 and 0.80, and 0.79 and 0.80 in those three cohorts. Conclusions: Our model shows the best prediction accuracy of the OS and CSS for patients with vulvar cancer (VC), which is of significant clinical practice value.

Radiotherapy Plus Chemotherapy Leads to Prolonged Survival in Patients With Anaplastic Thyroid Cancer Compared With Radiotherapy Alone Regardless of Surgical Resection and Distant Metastasis: A Retrospective Population Study.

Background: Whether anaplastic thyroid cancer (ATC) patients benefit more from radiotherapy plus chemotherapy (RCT) than from radiotherapy alone (RT) was controversial. We aimed to investigate the effectiveness of RCT versus RT on ATC overall and within subgroups by surgical resection and distant metastasis in a large real-world cohort. Methods: Patients with ATC diagnosed between 2004 and 2015 were identified from the Surveillance, Epidemiology, and End Results Program database. Inverse probability weighting (IPW) was performed to balance variables between the two groups. Multivariate Cox proportional hazard model and Fine-Gray compete-risk model were carried out to investigate prognostic factors relating to overall survival (OS) and cancer-specific survival (CSS). Subgroup analysis was carried out, and a forest plot was graphed. Results: Of the 491 ATC patients, 321 (65.4%) were in the RCT group and 170 (34.6%) were in the RT group. The median OS was 4 months [interquartile range (IQR) 2-7] and 2 months (IQR 1-4) for patients in the RCT and RT groups, respectively. As indicated by the inverse probability weighting multivariate regression, RCT was associated with significantly improved OS (adjusted HR = 0.69, 95% CI = 0.56-0.85, p < 0.001) and CSS (adjusted subdistribution HR = 0.77, 95% CI = 0.61-0.96, p = 0.018). The prominent effect of RCT versus RT alone remains significant within each subgroup stratified by surgical resection and distant metastasis. Older age, single marital status, surgical resection, distant metastasis, and tumor extension were significant prognostic factors of survival. Conclusions: RCT contributes to prolonged OS and CSS compared with RT alone in ATC patients, regardless of surgical resection and distant metastasis. RCT should be preferentially applied to ATC patients.

Safety and Benefit Of Sentinel Lymph Nodes Biopsy Compared to Regional Lymph Node Dissection in Primary Vulvar Cancer Patients Without Distant Metastasis and Adjacent Organ Invasion: A Retrospective Population Study.

BACKGROUND: The safety and benefit of sentinel lymph node biopsy (SLNB) compared with regional lymph node dissection (RLND) and no lymph nodes removed (NA) in patients with vulvar squamous cell cancer (VSCC) was not well studied. METHODS: A retrospective analysis on VSCC patients without distant metastasis and adjacent organ invasion from the Surveillance, Epidemiology, and End Results Program database between 2004 and 2016 was carried out. Within subgroups stratified by negative (LN-) or positive (LN+) regional lymph node findings, inverse probability weighting (IPW) adjusted multivariate Fine-Gray compete risk (CR) model and accelerated failure time (AFT) model was used to investigate the factors associated with and cancer-specific survival (CSS) and overall survival (OS). RESULTS: Of the 3,161 VSCC patients treated with surgery, 287 (9.1%) underwent SLNB, 1,716 (54.3%) underwent RLND, and 1,158 (36.6%) had no regional lymph nodes removed. As illustrated by IPW adjusted multivariate regressions, SLNB was significantly associated with prolonged CSS (LN-, adjusted sub-proportional hazard ratio [sHR] = 0.42; 95% confidence interval [CI], 0.19-0.93; P=0.032; LN+, adjusted sHR = 0.29; 95% CI, 0.16-0.54, P<0.001) and OS (LN-, adjusted time ratio [TR] = 1.38; 95% CI, 0.82-2.32; P=0.226; LN+, adjusted TR = 2.68; 95% CI, 1.73-4.14; P<0.001), although the effect of SLNB on OS was not significant within the LN- cohort. Moreover, SLNB led to improved CSS (adjusted sHR = 0.40; 95% CI, 0.23-0.70; P = 0.001) and OS (adjusted TR=1.15, 95% CI 0.76-1.73, P=0.279) compared with NA. Age was a significant prognostic factor of CSS and OS, whereas tumor size, surgery type, and invasion depth were not. CONCLUSIONS: SLNB leads to significantly prolonged CSS and OS in VSCC surgery patients without distant metastasis and adjacent organ invasion than RLND, except for the similar OS in the LN- cohort. SLNB could be carried out preferentially for VSCC surgery patients without distant metastasis and adjacent organ invasion, irrespective of tumor size, surgery type, invasion depth, and regional lymph nodes metastasis. Further prospective clinical trials are warranted to confirm the findings of this study.

Se transformation and removal by a cattail litter treatment system inoculated with sulfur-based denitrification sludge: Role of the microbial community composition under various temperature and aeration conditions.

With a narrow margin between deficiency and toxicity, rising levels of selenium (Se) are threatening aquatic ecosystems. To investigate the role of microorganisms in Se bioremediation, a cattail litter system inoculated with the sulfur-based denitrification sludge was conducted. The results show the litter, as a carrier and nutrient source for bacteria, efficiently removed Se by ~ 97.0% during a 12-d treatment with water circulating. As the major removal pathways, immobilization rates of selenite were ~ 2.9-fold higher than selenate, and the volatilization, contributing to ~ 87.7% of the total Se removal, was significantly correlated with temperature (positively) and oxidation-reduction potential (ORP; negatively). Using X-ray absorption spectroscopy to speciate litter-borne Se, more Se0 formed without aeration due to abundant Se-reducing bacteria, among which Azospira and Azospirillum were highly related to the removal of both Se oxyanions, while Desulfovibrio, Azoarcus, Sulfurospirillum, Thauera, Geobacter, Clostridium, and Pediococcus were the major contributors to selenate removal. Overall, our study suggests microbial Se metabolism in the litter system was significantly affected by temperature and ORP, which could be manipulated to enhance Se removal efficiency and the transformation of selenate/selenite into low toxic Se0 and volatile Se, reducing risks posed by the residual Se in the system.

Salinity-driven nitrogen removal and its quantitative molecular mechanisms in artificial tidal wetlands.

The present study investigated the performance in nitrogen removal and associated nitrogen transformation processes in seven mesocosms fed with saline water (0‰ to 30‰) to simulate tidal flow constructed wetlands (TF CWs). The highly effective and steady removal of NH4+-N (84.74% averagely) was obtained at various salinities, while the rates varied from 6.34% to 89.19% and 22.54% to 87.48% for NO3--N and total nitrogen (TN), respectively. Overall, nitrogen removal efficiencies were greater at lower salinities. Molecular biological analyses verified the co-occurrence of dissimilatory nitrate reduction to ammonium (DNRA), denitrification, anaerobic ammonium oxidation (anammox) and nitrification in the mesocosms, reportedly contributing to nitrogen removal in TF CWs. The absolute copy numbers of nitrogen functional genes and total bacterial 16S rRNA were 2.54 × 103-7.35 × 107 and 3.21 × 107-7.82 × 109 copies g-1 dg (dry gravel), respectively, with the dominant phyla, i.e., Chloroflexi, Proteobacteria, Actinobacteriota, Cyanobacteria, and Firmicutes, accounting for over 80% of the sequences. The relative abundances of the genera related to nitrification and dissimilatory nitrate reduction processes, i.e., denitrification, anammox and DNRA, varied from 0.16% to 0.89% and from 3.66% to 11.59%, respectively, while quantitative relationships confirmed NH4+-N transformation rate was jointly controlled by amoA, hzsB, nxrA and nrfA, and NO3--N removal rate by nirS, nosZ, narG, qnorB and nxrA. These findings may shed light on quantitative molecular mechanisms for nitrogen removal in TF CWs for the saline water treatment, providing a sustainable solution to nitrogen pollution problem in the estuary ecosystem.

Selenium uptake, volatilization, and transformation by the cyanobacterium Microcystis aeruginosa and post-treatment of Se-laden biomass.

With a narrow margin between beneficial and toxic effects, selenium (Se) is of great concern due to its increasing level in aquatic environments. The accumulation and transformation of Se by the cyanobacterium Microcystis aeruginosa and effects of nutrients, particularly sulfate, were investigated. The nutrient-deprived cyanobacterium removed water-borne selenate (82.2 ± 0.93%) faster than selenite (58.9 ± 1.77%), with 86.0 ± 1.41% and 77.2 ± 1.00%, respectively, of the Se accumulated in the biomass and the rest volatilized. When supplied with excess nutrients, the Se accumulation and volatilization rates were significantly inhibited, with the removal efficiency dropping to 50.2 ± 2.59% and 7.37 ± 0.93% for selenite and selenate, respectively. When M. aeruginosa was tested with inadequate, appropriate, and adequate levels of sulfate, Se uptake decreased with increasing sulfate concentrations, particularly for selenate (from 34.1 to 4.81%). Using X-ray absorption near-edge structure to speciate biomass Se, selenite and selenate were transformed to organo-Se (87.3-100%), with or without nutrients present, suggesting M. aeruginosa could efficiently reduce Se oxyanions to more bioavailable forms. With increasing sulfate levels (5.0 and 10.0 mg S/L), percentages of SeMet converted from selenite decreased by 28.2-33.0%, with 19.1-33.2% as elemental Se, while organo-Se remained dominant (93.6-95.1%) in selenate-treated M. aeruginosa. Transmission electron microscopy shows structural damage in the cell wall at exposure to selenite (1600 µg Se/L), with the intracellular structure intact. To prevent Se biomagnification along aquatic food chains, the Se-laden biomass was combusted as a post-treatment, leading to a significant reduction in Se content (∼99.2%) and Se bioavailability, with inorganic Se (45.0-70.5%) predominant in the residue.

Robert's uterus with delayed diagnosis and potential consequences: a case report.

A 24-year-old woman who wished to become pregnant presented to our hospital with an enlarged ovarian endometrioma and developmental abnormality of the uterus. Robert's uterus complicated by hematosalpinx, ovarian endometrioma, and endometriosis were finally identified 1 year after previously being diagnosed with a cyst and uterine abnormality at a local hospital. The function of the salpinx and the pelvic environment were damaged because of the delayed diagnosis and operation. Gynecologists and sonologists should be aware of and alert to this rare entity while evaluating and managing cases of uterine abnormalities and endometriosis. Prompt early diagnosis and proper management of Robert's uterus are important for avoiding future morbidity because these are major factors in protecting fertility.

Remediation of selenium-contaminated soil through combined use of earthworm Eisenia fetida and organic materials.

Selenium (Se)-polluted soils pose serious threats to terrestrial ecosystems through food chains. This study evaluated the use of earthworm Eisenia fetida and organic materials for Se remediation. The greater mortality (6.7%) and weight loss (28.6%) were observed for earthworms exposed to selenate than selenite at 20 mg Se Kg-1 over 21 d, while selenate was taken up 2.5-fold faster than selenite. Compared with peat moss, Se accumulation increased by 119% in selenite-exposed earthworms supplied with cow manure. Earthworm activity caused greater reduction in selenite (17.4%), with little impact on selenate-treated soil. X-ray absorption spectroscopy speciation analysis shows 87-91% of tissue Se was transformed to organo-Se, i.e., SeMet and SeCys, in earthworms exposed to either selenite or selenate, posing great risks to their predators. The study also found selenium increased bacterial diversity in earthworm casts, while greater relative abundances (~37.57%) of functional genera were obtained for selenite. Over 24 h, two bacteria strains, Bacillus cereus and Aeromonas encheleia, isolated from casts, rapidly reduced selenite by ~94%, compared to ~25% for selenate. Elemental Se was present only in strains (~27%), casts (~11%) and worm-inhabited soil (~2.7%) of selenite treatments, suggesting earthworm gut microbiota could buffer earthworms and other soil fauna from selenite toxicity.

Sulfur transformation in sulfur autotrophic denitrification using thiosulfate as electron donor.

Thiosulfate is frequently used as an energy source and electron donor in autotrophic denitrification (AD) for removing nitrate from wastewater. However, transforming pathways of S2O32- in this process is unclear. Herein, the aim of this study is to explore possible transforming pathways of sulfur compounds in thiosulfate-based AD process. After measuring the variation of NO3-, NO2-, and various sulfur compounds such as S0, SO42-, S2O32-, acid volatile sulfide (AVS), and S2- in the presence and absence of S2O32-, the variation process of S2O32- and the contribution of various sulfur compounds were analyzed. The results indicated that S0, AVS, and S2- were the intermediate products when S2O32- was applied as an electron donor. All S2O32-, S0, AVS, and S2- could act as electron donors in the nitrate removal process with the final products of SO42-. The utilization priority of these four sulfur sources was presumed in the following order: S2- > S2O32- > AVS ≈ S0. Furthermore, sulfur transformation and balance in nitrate removal process was also investigated. This suggests the transforming pathways of sulfur compounds in denitrification process. Nitrogen removal and sulfur conversion process are dependent on the presence of microorganisms in the sludge.

Nitrogen removal through collaborative microbial pathways in tidal flow constructed wetlands.

Constructed wetlands are efficient in removing nitrogen from water; however, little is known about nitrogen-cycling pathways for nitrogen loss from tidal flow constructed wetlands. This study conducted molecular and stable isotopic analyses to investigate potential dissimilatory nitrate reduction to ammonium (DNRA), denitrification, nitrification, anaerobic ammonium oxidation (anammox), and their contributions to nitrogen removal by two tidal wetland mesocosms, PA (planted with Phragmites australis) and NP (unplanted), designated to treat Yangtze River Estuary water. Our results show the mesocosms removed ~22.6% of TN from nitrate-dominated river water (1.19 mg·L-1), with better performance obtained in PA than that in NP, which was consistent with the molecular and stable isotopic data. The potential activities of DNRA, anammox, denitrification and nitrification varied between 0.6 and 1.6, 4.6-37.3, 36.4-305.7, and 463.7-945.9 nmol N2 g-1 dry soil d-1, respectively, with higher values obtained in PA than NP. Nitrification accounted for 94.3-99.4% of NH4+ oxidation, with the rest through anammox. Denitrification contributed to 77.9-90.3% of NOx- reduction, compared to 9.2-21.6% and 0.5-1.5% via anammox and DNRA, respectively; 78.4-90.9% of N2 was produced through denitrification, with the rest via anammox. Pearson correlation analyses suggest NH4+ was the major factor regulating nitrification, while NO3- played an important role in the competition between denitrification and DNRA, and NO2- was a key restrictive factor for anammox. Overall, this study reveals the importance of nitrification, denitrification, anammox and DNRA in nitrogen removal, providing new insight into the nitrogen-cycling mechanisms in natural/artificial tidal wetlands.

Survival benefit of vaginectomy compared to local tumor excision in women with FIGO stage I and II primary vaginal carcinoma: a SEER study.

PURPOSE: The effectiveness of vaginectomy compared to that of local tumor excision (LTE) for the International Federation of Gynecology and Obstetrics (FIGO) stage I and II vaginal carcinoma is unclear. We aimed to clarify if the effectiveness of vaginectomy is comparable to that of LTE in the real world. METHODS: We retrospectively evaluated data of patients with primary vaginal carcinoma registered in the Surveillance, Epidemiology, and End Results Program (SEER) database from 2004 to 2016. The multivariate Cox proportional hazards models and Fine-Gray competing risk models were used to estimate the overall survival (OS) and disease-specific survival (DSS) after propensity score matching. RESULTS: Of the 533 patients with FIGO stage I and II primary vaginal carcinoma, 243 and 290 patients were treated with vaginectomy and LTE, respectively. Vaginectomy was significantly associated with improved OS [unadjusted hazard ratio (HR) = 0.70, 95% confidence interval (CI) 0.53-0.95, P = 0.020; adjusted HR = 0.63, 95% CI 0.46-0.87, P = 0.005] and DSS [unadjusted subdistribution HR (sHR) = 0.75, 95% CI 0.52-1.07, P = 0.115; adjusted sHR = 0.65, 95% CI 0.44-0.97, P = 0.036]. Age, marital status, histology type, FIGO stage, chemotherapy, and lymph node metastases were significant prognostic factors of survival. Moreover, radiotherapy did not influence the effectiveness of vaginectomy. Subgroup and sensitivity analysis confirmed the consistent beneficial effectiveness of vaginectomy. CONCLUSION: Compared with LTE, vaginectomy results in significantly prolonged survival in patients with FIGO stage I and II primary vaginal carcinoma. Thus, it can be the preferred treatment for FIGO I and II vaginal cancer regardless of radiotherapy status.

Selenium removal by clam shells and gravels amended with cattail and reed litter.

Increasing selenium (Se) levels in aquatic environments raise concerns all over the world. This study investigated effects of organic amendments (cattail and reed litter) and porous media (gravels and clam shells) on Se removal efficiency of horizontal subsurface flow constructed wetlands. Our results show clam shells reduced Se (by mass) up to 2.4-fold faster than gravels within 19 days. Using clam shells as the sole substrate, 96.3% removal efficiency was obtained for cattail litter as an amendment, compared to 88.7% for reed litter over 10 days, although the latter released carbon and nitrogen at least 1.4-fold faster than the former. Meanwhile, speciation analysis suggests Se0 (~75%) and organo-Se (~94%) dominated the biofilms on shells and plant litter, respectively, as substrates. Overall, this study suggests clam shells and cattail litter as an effective medium and carbon source, respectively, can enhance microbial Se removal without posing risks to wildlife health.

Mutual effects of selenium and chromium on their removal by Chlorella vulgaris and associated toxicity.

The release of selenium (Se) and chromium (Cr) into the environment from anthropogenic activities has posed a hazard to aquatic ecosystems. In this study, we used Chlorella vulgaris for Se/Cr bioremediation and evaluated their mutual effects on the removal efficiency. Our results found C. vulgaris highly effective in removing selenite-Se(IV) (49.5 ± 1.9%), selenate-Se(VI) (93.0 ± 0.5%), chromic nitrate-Cr(III) (89.0 ± 3.2%) and dichromate-Cr(VI) (88.1 ± 1.3%) over a 72 h period. Cr(VI) significantly impeded Se removal, particularly for selenate, due to competition between both for algal uptake, whereas Cr(III) obviously enhanced Se removal, increasing Se volatilization by ~29%. Similarly, Se significantly increase Cr removal rates, with a maximum of 94.6 ± 0.2% for the algal co-exposed to Se(IV) and Cr(III). To reduce residual pollutants in the alga, we applied combustion as a post-treatment to burn off >99% of the biomass Se for all Se treatments, whereas most of the biomass Cr (54.7-81.6%) remained in the ash at significantly higher levels (~7430 µg Cr/g DW). For toxicity, our speciation analysis found organo-Se (SeCys and SeMet) dominant in the alga exposed to Se, particularly selenite. No Cr(VI) but Cr(III) forms were detected in all Cr-exposed alga. Elemental Se disappeared from all Se-exposed alga in the presence of Cr(VI), while Se resulted in the emergence of Cr-acetate in all Cr(III)-treated alga. After combustion, mineral Se, particularly elemental Se dominated most of the ash; likewise, elemental Cr, along with Cr2O3, was found in all the ash. Overall, our research would contribute to developing a low ecotoxic algal treatment system for Se/Cr contaminated water.

Trophic transfer and biotransformation of selenium in the mosquito (Aedes albopictus) and interactive effects with hexavalent chromium.

As an essential micronutrient for animals with a narrow range between essentiality and toxicity, selenium (Se) usually coexists with chromium (Cr) in contaminated aquatic environments. This study investigated effects of three diets (Microcystis aeruginosa, Chlorella vulgaris and biofilms) exposed to Se or/and Cr on Aedes albopictus as a vector for the aquatic-terrestrial transfer of Se and Cr. Se(IV)-exposed mosquitoes concentrated Se up to 66-fold faster than Se(VI)-exposed ones, corresponding to the greater Se enrichment in Se(IV)-treated diets. Analysis using synchrotron-based X-ray absorption spectroscopy (XAS) showed that Se(0) (61.9-74.6%) dominated Se(VI)-exposed mosquitoes except for the C. vulgaris-fed larvae (organo-Se, 94.0%), while organo-Se accounted for 93.3-100.0% in Se(IV)-exposed mosquitoes. Cr accumulation in larvae (56.40-87.24 µg Cr/g DW) or adults (19.41-50.77 µg Cr/g DW) was not significantly different among all Cr(VI) treatments, despite varying diet Cr levels. With Cr(0) being dominant (57.7-94.0%), Cr(VI)-exposed mosquitoes posed little threat to predators. Although mosquitoes exposed to Se or Cr had shorter wings, adults supplied with C. vulgaris or biofilms co-exposed to Se(VI) and Cr(VI) had wings significantly (1.1-1.2 fold) longer than Se(VI) only exposed ones. Overall, our study reveals the role of Ae. albopictus in transferring waterborne Se and Cr from the contaminated aquatic ecosystem to the terrestrial ecosystem with the resulting eco-risks to wildlife in both ecosystems.