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Objective To study the risk factors leading to type II/III cesarean scar pregnancy and evaluate the efficacy of hysteroscopic treatment and subsequent reproductive outcomes. Design Retrospective study from 2013 to 2018. Setting Inpatient samples. Patient(s) A total of 439 patients with cesarean scar pregnancy received hysteroscopic treatment. They were grouped according to the type of surgery as hysteroscopy combined with dilation and curettage, systemic methotrexate followed by hysteroscopy combined with dilation and curettage, and uterine artery embolization or laparoscopic ligation of bilateral uterine arteries followed by hysteroscopy combined with dilation and curettage. Cesarean scar pregnancy was classified as types I, II, and III on the basis of the relationship between the gestational sac and myometrial thickness by ultrasound. Intervention(s) Not applicable. Main Outcome Measure(s) Risk factors leading to type II/III cesarean scar pregnancy. The success of hysteroscopic treatment as well as favorable reproductive outcomes. Result(s) The significant variables were multiple parity, prior cesarean section (CS), hysteroscopic therapy, and dilation and curettage after the last CS between type I and type II/III. There were significant differences among the three groups in symptoms, largest diameter of the gestational sac, presence of fetal heartbeat, myometrial thickness, type of cesarean scar pregnancy, blood loss, length of hospital stay, and expense. The rates of complications and success were 8.2% and 93.6%, respectively. Thirty-seven women conceived again, and 22 women completed a term pregnancy with no uterine rupture. The recurrence rate of cesarean scar pregnancy was 10.8%. Conclusions The type of cesarean scar pregnancy is related to the rates of multiple parity, cesarean deliveries, and dilation and curettage procedures after the last CS. Hysteroscopic therapy is a safe and effective surgical approach with a low risk of subsequent ectopic pregnancy.

Background: Ovarian cancer (OC) lacks specific symptoms and screening methods, and most patients are diagnosed at an advanced stage with worse prognosis. Currently, the major treatment approaches for advanced epithelial ovarian carcinoma (AEOC) have been primary debulking surgery (PDS) followed by platinum-based chemotherapy, and neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS). Serum CA125 has been widely used as an indicator for OC diagnosis and management. It is generally believed that preoperative serum CA125 level is associated with tumor burden, and some studies have attempted to evaluate its level to obtain optimal resection rate. HE4 is also a promising biomarker for OC. The aim of the study is to explore whether serum CA125 and HE4 levels in stage III epithelial ovarian cancer predict optimal surgical cytoreductive outcomes. Methods: The clinical data of 201 stage III ovarian cancer patients, diagnosed at our institution from January 2013 to June 2019, were retrospectively collected. According to the initial treatment modality, patients were divided into groups: NACT followed by IDS (89 women) group and by PDS (112 women) group. Differences in patient characteristics were compared using the chi-square test and t-test, and disease-free survival (DFS) was calculated using the Kaplan-Meier method. ROC analysis was used to determine the cut-off values of serum CA-125 and HE4. Results: The medium initial serum levels of CA125 (1359.6 IU/ml vs.759.5 IU/ml, p ˂ 0.001) and HE4 (661 pmol/L vs. 244 pmol/L, p ˂ 0.001) were significantly higher in the NACT group compared with those in the PDS group. Serum CA125 and HE4 levels after NACT decreased by 96.30% and 96.23%, respectively. If the preoperative serum CA-125 value was 500 IU/ml, the probability of achieving R0 was 63.9%. When the preoperative serum HE4 value was 250pmol/L, there was a 65.80% chance of obtaining complete gross cytoreduction. The median DFS was 20 months and 20.5 months in the NACT and PDS groups, respectively. No significant difference in DFS was observed between the two groups (p = 0.851). Conclusion: The efficacy of NACT combined with IDS treatment and PDS for advanced ovarian cancer are comparable. Initial serum CA125 and HE4 levels of 500IU/ml and 250 pmol/L are appropriate cut-off values for predicting the absence of gross residual lesions. CA125 and HE4 values can serve as predictors of optimal surgical cytoreduction. Nevertheless, more clinical studies are needed for further validation.

Replacing natural gas with the environmentally sustainable biogas is a promising way to reduce the usage of fossil fuels and promote organic waste utilization. Micro gas turbine (MGT), as a common power supply machine, is capable of adopting biogas as the fuel. Given the different intrinsic components between natural gas and biogas, combustion performance of biogas in MGT was studied in this work. The effects of fuel composition and excess air coefficient on combustion performance were analyzed through three-dimensional numerical simulation of the MGT combustor. RNG k-e turbulent model, eddy-dissipation/finite rate model, and eight-step reaction mechanism were adopted in the simulation. The results showed that when the CO2 percentage in biogas increases, the NO and CO emissions decreases. However, the fuel rate and pressure drop of combustion chamber increases to maintain constant thermal input. The overall high velocity also increases the requirement for materials of combustion chamber. Furthermore, the average temperature of whole combustor decreases when the excess air coefficient increases. Accordingly, the CO2 mole fraction in biogas should be controlled below 30% and the optimal range of the excess air coefficient is 2–2.5 for the MGT.

Summary Hydrogen peroxide (H2O2) is receiving growing interest for energy storage because it can be locally synthesized from renewable energy through the two-electron water oxidation and the two-electron oxygen reduction reactions. Recently, engineering the microenvironment of existing catalysts has become a promising approach to address the activity, selectivity, and stability challenges of H2O2 synthesis and fuel cells, reducing the gap between theoretical prediction and experimental observations. We summarize these progresses from a multi-scale perspective, including tailoring the active sites on the catalytic surface, engineering the interface near the reactive sites, and improving the device design to achieve selective H2O2 conversion. Such strategies tune the thermodynamic energy barriers and reaction pathways, facilitate mass transfer for reactants and products, and stabilize the products and catalytic surfaces. The discussions here are expected to stimulate further efforts to achieve efficient on-site H2O2 production and power generation by H2O2 with high round-trip efficiency.

Introduction: A recent prospective randomized study demonstrated that minimally invasive surgery (MIS) was inferior to open surgery in disease survival in early-stage cervical cancer. Our aim was to investigate whether there were survival benefits of preoperative conization prior to MIS for early-stage cervical cancer. Methods: We retrospectively analyzed patients who eventually underwent definitive MIS with stage IA2 to IB1 (no >2 cm) squamous cell carcinoma, adenocarcinoma, and adenosquamous carcinoma. Preoperatively, the patients were separated into 2 groups: one managed with conization and the other undergoing biopsy without conization. Propensity scoring weight and matching were used to reduce the influence of possible allocation biases. The Cox regression model was used for univariate and multivariate analyses of disease recurrence and survival. Results: 227 patients were contained in this study (99 patients in the conization group and 128 patients in the nonconization group). The 5-year DFS of the conization group was statistically better than that of the nonconization group (98.4% vs. 91.8%, p = 0.011). By univariate analysis, conization (HR = 0.11, 95% CI = 0.01–0.87, p = 0.03) and histologic cell type (p = 0.01) were considered as risk factors for recurrence. Multivariate analysis further confirmed conization (HR = 0.04, 95% CI = 0.01–0.51, p = 0.01) and histologic cell type (p < 0.01) correlated with DFS. After propensity score matching (1:1), 84 patients were included in the conization and nonconization groups, respectively, with 5-year DFS still higher in the conization group (98.3% vs. 92.9%, p = 0.037). The results after univariate and multivariate analyses were consistent with those prior to propensity score matching. Conclusion: Preoperative conization in conjunction with MIS seemed to be a safe and feasible approach, with results that may have implications for the reduction of recurrence. Histologic cell type also impacted survival. Therefore, more future prospective studies are warranted.

PURPOSE This phase III trial aimed to explore the efficacy and safety of fuzuloparib (formerly fluzoparib) versus placebo as a maintenance treatment after response to second- or later-line platinum-based chemotherapy in patients with high-grade, platinum-sensitive, recurrent ovarian cancer. PATIENTS AND METHODS Patients with platinum-sensitive, recurrent ovarian cancer previously treated with at least two platinum-based regimens were assigned (2:1) to receive fuzuloparib (150 mg, twice daily) or matching placebo for 28-day cycles. The primary end points were progression-free survival (PFS) assessed by blinded independent review committee (BIRC) in the overall population and PFS by BIRC in the subpopulation with germline BRCA 1/2 mutation. RESULTS Between April 30, 2019, and January 10, 2020, 252 patients were randomly assigned to the fuzuloparib (n = 167) or placebo (n = 85). As of July 1, 2020, the median PFS per BIRC assessment in the overall population was significantly improved with fuzuloparib treatment (hazard ratio [HR], 0.25; 95% CI, 0.17 to 0.36; one-sided P < .0001) compared with that with placebo. The HR derived from a prespecified subgroup analysis showed a consistent trend of benefit in patients with germline BRCA 1/2 mutations (HR, 0.14; 95% CI, 0.07 to 0.28) or in those without mutations (HR, 0.46; 95% CI, 0.29 to 0.74). The most common grade ≥ 3 treatment-emergent adverse events reported in the fuzuloparib group were anemia (25.1%), decreased platelet count (16.8%), and decreased neutrophil count (12.6%). Only one patient (0.6%) discontinued fuzuloparib because of treatment-related toxicity (concurrent decreased white blood cell count and neutrophil count). CONCLUSION Fuzuloparib as maintenance therapy achieved a statistically significant and clinically meaningful improvement in PFS for patients with platinum-sensitive, recurrent ovarian cancer versus placebo, regardless of germline BRCA 1/2 mutation, and showed a manageable safety profile.

Objective. We aimed to compare the perioperative and survival outcomes of robotic-assisted surgery, traditional laparoscopy, and laparotomy approaches in ovarian cancer. Methods. PubMed, Cochrane Library, Embase, Web of Science, and Chinese National Knowledge Infrastructure (CNKI) were searched using multiple terms for ovarian cancer surgeries, including comparative studies in Chinese and English. Literatures are published before August 31, 2021. The outcomes include operating time, estimated blood loss, length of hospital stay, postoperative/intraoperative/total complications, pelvic/para-aortic/total lymph nodes, transfusion, and five-year overall survival rate. The dichotomous data, continuous data, and OS data were pooled and reported as relative risk, standardized mean differences, and hazard ratio HRs with 95% confidence intervals, respectively. The Newcastle–Ottawa Scale was used to evaluate the risk of bias of included studies. Results. Thirty-eight studies, including 8,367 patients and three different surgical approaches (robotic-assisted laparoscopy surgery, traditional laparoscopy, or laparotomy approaches), were included in this network meta-analysis. Our analysis shows that the operating time of laparotomy was shorter than laparoscopy. The robotic-assisted laparoscopy has the least estimated blood loss during the surgery, followed by laparoscopy, and finally laparotomy. Compared with laparotomy, the incidence of blood transfusion was lower in the robotic-assisted laparoscopy and laparoscopy groups, and the length of hospital stay is shorter. Laparotomy had a significantly higher incidence of total complications than robotic-assisted laparoscopy and laparoscopy and higher postoperative complications than laparoscopy. For the number of pelvic/para-aortic/total lymph nodes removed by different surgical approaches, our analysis revealed no statistical difference. Our analysis also revealed no significant differences in intraoperative complications and 5-year OS among the three surgical approaches. Conclusion. Compared with laparotomy, robotic-assisted laparoscopy and laparoscopy had a shorter hospital stay, decreased blood loss, fewer complications, and transfusion happened. The 5-year OS of ovarian cancer patients has no difference between robotic-assisted laparoscopy, laparoscopy, and laparotomy groups.

Background Endometriosis is a common benign gynecological disease characterized by growing-functioning endometrial tissue outside the uterus. Extra-pelvic endometriosis, which accounts for approximately 12% of endometriosis, is more challenging to diagnose because of its distance from the pelvic organs. Halban's theory of benign metastasis indicates that endometrial cells can appear in extra-pelvic organs via lymphatic and blood vessels, but endometrial lymph node metastasis cases are still rare. We report a case of endometriosis in a para-aortic lymph node whose clinical behavior mimicked a malignancy. Case presentation A 52-year-old perimenopausal woman underwent laparoscopic hysterectomy plus bilateral salpingectomy (the patient insisted on the preservation of her ovaries) at a local hospital 2 years earlier because of adenomyosis. The patient presented with a complaint of low back pain to the gastrointestinal outpatient department of our hospital. The carbohydrate antigen 125 (CA125) was abnormally elevated at 5280.20 U/ml, human epididymis 4 (HE4) was 86.0 pmol/L, while other tumor markers were normal. Serum female hormone results were in the postmenopausal range, and her gastroenteroscopy showed no abnormalities. Moreover, both enhanced magnetic resonance imaging and positron emission tomography-computed tomography showed a high possibility of a retroperitoneal malignant lymph node (metastasis possible, primary site unknown). One week after admission, she underwent laparoscopic exploratory surgery, during which we observed normal shape and size of both ovaries while the left ovary was cystic-solid. After opening the retroperitoneal space, an enlarged lymph node-like tissue measuring 8 × 4 × 3 cm3 was found near the abdominal aorta. When the surrounding adhesions were separated, lymph node-like tissue was poorly demarcated from the abdominal aorta and renal artery. Some lymph node samples and left ovary were sent for intraoperative frozen section, which revealed benign lesions, similar to endometrial tissue. The lymph node tissue was then excised as much as possible, and the second set of intraoperative frozen sections showed high probability of endometrial tissue. The final histopathology and immunohistochemistry staining reached a diagnosis of para-aortic lymph node endometriosis. Gonadotropin-releasing hormone antigen treatment was recommended every 28 days because of the high preoperative CA125 and imaging-based suspicion of malignancy. The serum CA125 subsequently decreased to normal levels, and no para-aortic lesions were detected on abdominal enhancement CT. She is being followed up regularly. Conclusion It is known that the incidence of lymph node metastasis in pelvic endometriosis is relatively rare. Our report shows that endometriotic tissue can metastasize via the lymphatic route and suggests that endometriotic tissue has the characteristics of invasion and metastasis.

Background Among the common preventable cancers of women, cervical cancer has the highest morbidity. It is curable if detected at an early stage. However, reliable diagnostic and prognostic markers, which relate to physiologic and pathologic regulation of cervical cancer, are not available. In this study, one such potential marker, ZBTB28, was evaluated for its potential usefulness in cervical cancer assessment. Methods Public database analysis, reverse-transcription polymerase chain reaction (PCR), and methylation-specific PCR were employed to analyze ZBTB28 expression and promoter methylation. The importance of ZBTB28 in cervical cancer cells was assessed by cellular and molecular analysis in vitro and in vivo. Results This study assessed the anti-tumor effects of the transcription factor, ZBTB28, which is often silenced in cervical cancer due to CpG methylation of its promoter. We found ZBTB28 to directly affect cervical cancer cell proliferation, apoptosis, autophagy, and tumorigenesis. Also, it increased cancer cell chemosensitivity to Paclitaxel, Cisplatin, and 5-fluorouracil. Ectopic ZBTB28 expression inhibited the growth of cervical cancer xenografts in nude mice. Furthermore, electron microscopy demonstrated ZBTB28 to induce autophagosomes in cervical cancer cells. ZBTB28 induced cellular autophagy by the degradation of Bcl-XL, reduction of the Bcl-XL-BECN1 complex, and by interaction with the autophagy-related gene FIP200. ZBTB28-induced autophagy of cervical cancer cells was shown to mediate cellular apoptosis through the regulation of FIP200. Conclusion These findings identify ZBTB28 as a tumor suppressor gene that can induce autophagy-related apoptosis in cervical cancer cells. As such, ZBTB28 may be a target for the treatment of uterine-cervical carcinoma. Further, ZBTB28 promoter methylation analysis may offer a new objective strategy for cervical cancer screening.

Objective Conflicting data have been published regarding the oncologic appropriateness of minimally invasive surgery (MIS) in the treatment of cervical cancer. The purpose of the present study was to investigate whether our experience in the treatment of early cervical cancer using a robotic surgical approach was safe and oncologically effective. Methods The data of 557 patients with cervical cancer treated by robotic surgery were retrospectively collected, including the perioperative and survival outcomes. Tumor stage was based on the International Federation of Gynecology and Obstetrics (FIGO 2009). The disease-free survival (DFS) and overall survival (OS) were calculated by the Kaplan–Meier method. Results Of the 557 patients, 196 (35.2%) patients were stage IA1 to IB1, and 304 (54.6%) patients were stage IB2 to I1A2. Also included were 57 (10.2%) patients with either recurrent or persistent disease following concurrent chemoradiotherapy. Two patients (0.4%) experienced severe intraoperative complications and 11 patients (2.0%) developed postoperative complications. A stratified analysis of survival was conducted in 91 patients who met a follow-up time of 3-year or more. The median follow-up time was 49 (range, 6–57) months. Both the 3-year DFS and OS of early-stage (stage IA1 to IB1) cervical cancer were 97.6%. For patients with locally advanced (stage IB2 to IIA2) disease, DFS and OS were 88.1% and 90.5%, respectively. The patients with recurrent or persistent disease had DFS and OS of 62.5%. Conclusion Our study results demonstrated that the robotic surgical approach could achieve satisfying therapeutic outcomes in patients with early-stage cervical cancer, with a low complication rate. For advanced cervical cancer patients with recurrent or persistent disease following concurrent chemoradiotherapy, robotic surgery undertaken as supplementary therapy may improve prognosis. However, there remains a need for additional prospective data reporting long-term survival of cervical cancer patients treated with a robotic surgical approach.

BackgroundCervical cancer is a type of cancer with the highest morbidity among the common preventable cancers in women. It is curable if detected in early stage. This kind of carcinoma is in need of reliable diagnostic and prognostic markers that involved in the regulation of its physiologic and pathological processes. However, the functions and mechanism of ZBTB28 in cervical cancer remain unclear.MethodsPublic database analysis, reverse-transcription PCR, and methylation-specific PCR were employed to analyze ZBTB28 expression and methylation. Tumor cellular functions were assessed via corresponding cellular and molecular biological approaches in vitro and in vivo.ResultsOur study contributed to the anti-tumor effect of transcription factor ZBTB28 which is often silenced in cervical cancer due to promoter CpG methylation. Via molecular and cellular approaches, we found that ectopic expression of ZBTB28 directly affected the biological function of cervical cancer including cell proliferation, apoptosis, autophagy and tumorigenesis, as well as chemosensitivity to Paclitaxel, Cisplatin and 5-FU. Ectopic ZBTB28 expression inhibited the growth of cervical cancer xenografts in nude mice. Furthermore, the electron microscopic photograph showed that ZBTB28 could induce the autophagosome in cervical cancer cells. ZBTB28 resulted in autophagy through degradation of Bcl-XL and reduction of the Bcl-XL–BECN1 complex, but also interacted with autophagy-related gene FIP200. It is worth noticing that ZBTB28-induced autophagy of cervical cancer to mediate cell apoptosis through the regulation of FIP200.ConclusionOur findings enriched the functional diversity of ZBTB28 as a tumor suppressor gene, also illustrated that ZBTB28 could lead to autophagy-related apoptosis in cervical cancer, implying that ZBTB28 may be a target for the treatment of carcinoma of uterine cervix, and detection of ZBTB28 methylation can offer a new objective strategy for screening of cervical cancer.

Additional file of ZBTB28 induces autophagy by regulation of FIP200 and Bcl-XL facilitating cervical cancer cell apoptosis

Additional file 1: Table S1 Diagnostic efficacy of HPV and ZBTB28 methylation in cervical cancer tissues. Table S2 List of RT-PCR primers. Table S3 List of qRT-PCR Primers. Table S4 List of ChIP-PCR Primers.

Additional file 2: Figure S1. Nucleus localization of ZBTB28. The localization of ZBTB28 and vimentin or Ecad in the nucleus of HeLa was analyzed by immunofluorescence. Figure S2. Regulation of ZBTB28 on Bcl-2 family proteins. (A) The expression of BECN1 was analyzed. (B, C) The expression of BCL2 and MCL1 was analyzed by qRT-PCR. (D) Promoter luciferase activity of Bcl-XL in cervical cancer cells. Figure S3. ZBTB28 regulated ATG16L2 in cervical cancer cells. (A, B) qRT-PCR results of ATGs mRNA expression in stable transfected cervical cancer cells. (C) Structure of wild-type ATG16L2 reporter plasmid. (D) % input of ATG16L2 DNA by HA-tag antibody were detected by ChIP-PCR. (E) Use dual luciferase reporter system to detect the effect of ZBTB28 on ATG16L2 promoter activity in 293T, CaSki and HeLa cells.

Objectives: Fuzuloparib (formerly fluzoparib), a poly (ADP-ribose) polymerase inhibitor, has shown promising antitumor activity and acceptable safety for the treatment of relapsed ovarian cancer patients harboring the BRCA1/2 mutation after 2-4 lines of platinum-based chemotherapy in previous phase 2 trial. This study aimed to assess the efficacy and safety of fuzuloparib versus placebo as maintenance treatment for patients with platinum-sensitive, recurrent ovarian cancer. Methods: This is a multicenter, double-blind, randomized, placebo-controlled, phase 3 trial conducted at 36 sites in China. Eligible patients had platinum-sensitive, relapsed, high-grade serious ovarian, fallopian tube, primary peritoneal or endometrioid ovarian carcinoma (≥grade 2), had received at least two prior platinum-based regimens and had achieved complete or partial response to their last platinum-based regimen. Patients were randomly assigned in a 2:1 ratio to fuzuloparib (150 mg, twice daily) or matching placebo using an interactive web response system. Randomization was stratified by BRCA1/2 mutation (presence or absence), progression-free interval after penultimate platinum-based regimen (6-12 months or >12 months) and best response to most recent regimen (complete or partial response). The co-primary endpoints were progression-free survival (PFS) assessed by blinded independent central review (BICR) in the overall population and in the BRCA1/2 mutation population. Here, we reported the results of the prespecified interim analysis from this ongoing study, which was planned for formal statistical testing on PFS per BICR in the overall population. Results: Between Apr. 30, 2019 and Jan. 10, 2020, 252 patients were randomly assigned to the fuzuloparib (n=167) or placebo (n=85). BRCA1/2 mutations were confirmed in 100 (39.7%) patients. Sixty-one (24.2%) patients had received more than two lines of previous platinum-based regimen, and 127 (50.4%) patients had the complete response to the most recent regimen. As of Jul 1, 2020, the median PFS per BICR assessment in the overall population was significantly improved with fuzuloparib (hazard ratio [HR], 0.25; 95% CI, 0.17-0.36; one-sided P Download : Download high-res image (76KB) Download : Download full-size image Conclusions: Fuzuloparib as maintenance therapy achieved a statistically significant and clinically meaningful improvement in PFS for patients with platinum-sensitive, relapsed ovarian cancer compared with placebo, regardless of BRCA1/2 mutation, and had a manageable safety profile.

High-intensity nanosecond pulsed electric fields (nsPEFs) are a novel treatment with promising applications for cell stimulation and tissue ablation, and many research studies have shown that gold nanorods (GNRs) are high-conductivity nanomaterials that can enhance electroporation for biomedical applications. In addition, the folic acid (FA) receptor has been demonstrated as a valuable therapeutic target that is highly expressed in a variety of cancers. To reduce the electric field strength required to treat tumors by nsPEFs, for the first time, gold nanorods with folic acid were proposed to achieve higher antimelanoma efficacy at lower electric field intensity in this study. The surface of polyethylene glycol-gold nanorods with good biocompatibility was further modified by folic acid (FA) to provide modified gold nanorods (GNR-PEG-FA) with specific targeted recognition of A375 melanoma cells. The binding of GNRs to A375 melanoma cells was observed by dark field microscopy. After combined treatment with nsPEFs and GNRs, cell viability was evaluated by a CCK-8 assay. Flow cytometry was performed to evaluate apoptosis and the cell cycle. And active caspase 3 was also detected after treatment. The antimelanoma efficacy was enhanced in a pulsed electric field-dependent manner. More importantly, compared with the group of nsPEFs alone and gold nanorods without FA, treating cells with nsPEFs combined with GNR-PEG-FA resulted in a lower percentage of viable cells, higher percentages of necrosis and apoptosis and higher concentration of active caspase 3 and induced cell cycle arrest in S phase, effectively inhibiting the proliferation of A375 melanoma cells. nsPEFs combined with GNR-PEG-FA showed the best antimelanoma efficacy in vitro and effectively killed melanoma cells with low-intensity nsPEFs. The combined treatment of cells with nsPEFs and GNR-PEG-FA is expected to become a safer and more efficient physical treatment of melanomas.

The reasonable design and optimization can be useful tools to solve issues in several industrial applications. Since it is time-consuming and costly to do the experimental performance assessment using various equipments, computational fluid dynamics (CFD) with suitable models has been widely used due to the good agreement with experiments. This paper presented a universal design calculation method of a volute swirl burner with central gas supply. Then, CFD simulations with standard k–e model, under non-reacting and reacting conditions, were carried out to verify the design feasibility. The mixedness of gas/air under non-reacting condition was evaluated from the perspective of normal distribution in statistics and checked by the designed excess air factor. A parametric study for various mixing section lengths and outlet diameters of the burner block was conducted to investigate their influence on the central recirculation zone and the temperature distribution. Simulation results show good agreement with empirical formula calculation. The gas and air have been mixed uniformly around the location that is 60 times of the gas orifice diameter. Additionally, an enlarged recirculation zone with increased recirculation strength can be formed with the increasing mixing length and block outlet diameter. In combustion simulation, the longer mixing length improves the flame stabilization but makes the combustion center move to the upstream of the burner due to the strengthened recirculation zone. The larger outlet diameter of the block stretches the flame and moves the high-temperature zone inside the flame to the downstream of the block wall.

Compared with atmospheric burner, porous infrared radiation burner has higher thermal efficiency. In this study, an infrared radiation burner with metal plaque was studied experimentally and numerically. The experimental results show that the thermal efficiency is 60.6% without blow-off, flashback, or lifted-flame during the continuous combustion for 60 min. The simulation with suitable kinetic parameters of chemical reaction agrees well with the experimental results. Moreover, a parametric study concerned with the plaque porosity, bore diameter, and thermal load was conducted by the validated model. The results show that the flame temperature increases when the bore diameter or the thermal load increases but decreases with the enlarged porosity. The upper surface temperature increases linearly with the improved thermal load but decreases when the porosity increases, and the bore diameter has a negligible effect on it. The nitrogen oxide (NOx) emission is positively correlated to the combustion temperature.

To study the electroporation characteristics of cells under high-frequency nanosecond pulse bursts (HFnsPBs), the original electroporation mathematical model was improved. By setting a threshold value for irreversible electroporation (IRE) and considering the effect of an electric field on the surface tension of a cell membrane, a mathematical model of electroporation considering the effect of IRE is proposed for the first time. A typical two-dimensional cell system was discretized into nodes using MATLAB, and a mesh transport network method (MTNM) model was established for simulation. The dynamic processes of single-cell electroporation and molecular transport under the application of 50 unipolar HFnsPBs with field intensities of 9 kV cm−1 and different frequencies (10 kHz, 100 kHz and 500 kHz) to the target system was simulated with a 300 s simulation time. The IRE characteristics and molecular transport were evaluated. In addition, a PI fluorescent dye assay was designed to verify the correctness of the model by providing time-domain and spatial results that were compared with the simulation results. The simulation achieved IRE and demonstrated the cumulative effects of multipulse bursts and intraburst frequency on irreversible pores. The model can also reflect the cumulative effect of multipulse bursts on reversible pores by introducing an assumption of stable reversible pores. The experimental results agreed qualitatively with the simulation results. A relative calibration of the fluorescence data gave time-domain molecular transport results that were quantitatively similar to the simulation results. This article reveals the cell electroporation characteristics under HFnsPBs from a mechanism perspective and has important guidance for fields involving the IRE of cells.

The presence of pathogenic bacteria and the dissemination of antibiotic resistance genes (ARGs) may pose big risks to the rivers that receive the effluent from municipal wastewater treatment plants (WWTPs). In this study, we investigated the changes of bacterial community and ARGs along treatment processes of one WWTP, and examined the effects of the effluent discharge on the bacterial community and ARGs in the receiving river. Pyrosequencing was applied to reveal bacterial community composition including potential bacterial pathogen, and Illumina high-throughput sequencing was used for profiling ARGs. The results showed that the WWTP had good removal efficiency on potential pathogenic bacteria (especially Arcobacter butzleri) and ARGs. Moreover, the bacterial communities of downstream and upstream of the river showed no significant difference. However, the increase in the abundance of potential pathogens and ARGs at effluent outfall was observed, indicating that WWTP effluent might contribute to the dissemination of potential pathogenic bacteria and ARGs in the receiving river.

Rationale: Pelvic exenteration is considered a method to treat central recurrent or persistent gynecologic malignancy after the initial therapy. The postoperative survival rate has been greatly increased by the improvement in the surgical technology and the perioperative management. Yet various complications are still impacting the quality of life. New technologies such as robotic surgery system made it possible to approach radical surgical resection by using a minimally invasive method. Patient concerns: The patient is a 53-year-old female with the cervical adenocarcinoma pelvic recurrence who had undergone the adjuvant chemo-radiotherapy and the laparoscopic radical hysterectomy in our hospital 2 years ago. She still expected her life to be prolonged through surgery therapy. Diagnoses: Locoregional recurrence of cervical adenocarcinoma. Interventions: A robotic total pelvic exenteration with ileal neobladder was performed. Outcomes: The postoperative results were excellent and after 17-month follow-up, the patient is alive and satisfied without any recurrence or distant metastasis. Lessons: For the patients with advanced or recurrent cervical cancer who are willing to receive surgical therapy and not sensitive to chemo-radiotherapy, robotic-assisted laparoscopic total pelvic exenteration is technically a feasible surgical method for recurrent pelvic malignancies. Yet the operation time should be further controlled to reduce complications which include pressure sore and thrombus. Moreover, appropriate assessment is required in the selection of the methods for reconstruction.

The purpose of this paper was to study the effect of different parameters of high frequency nanosecond pulse bursts on the rabbit muscle contraction strength. Ten unipolar high frequency pulse bursts with different field intensities (1 kV/cm, 4 kV/cm and 8 kV/cm), intra-burst frequencies (10 kHz, 100 kHz and 1 MHz) and intra-burst pulse numbers (1, 10 and 100) were applied through a pair of plate electrode to the surface skin of the rabbit's biceps femoris, and the acceleration signal of muscle contraction near the electrode was measured with a three axis acceleration sensor. The time and frequency domain characteristics of the acceleration signals were analyzed. The animals show dose-dependent increase in the amplitude of the acceleration signal of the muscle contraction. However, the spectral distributions of the signals are similar under different pulse bursts. Further analysis of the experimental results illustrates when the intra-burst frequency is relatively low, appropriate increase in the intra-burst pulse numbers will not increase muscle contraction strength significantly; however when the intra-burst frequency is relatively high, the intra-burst pulse numbers should be minimized as far as possible. This will provide reference for the selection of parameters in the actual tumor treatment performed with high frequency nanosecond pulses in the future.

In order to get in vivo evidences of nanosecond pulsed electric fields (nsPEF) for skin tumor treatment, tumor models in 10 female BALB/c nude mice were established by inoculating them with human melanoma cells A375. These mice were randomly divided into treated group (exposed to nsPEF with intensity of 20 kV/cm and duration of 300 ns) and control group equally. Five days post-nsPEF treatment, tumor growth in the treated group was effectively inhibited ( P < 0.01 compared with that in control group), typical apoptotic characteristics (DNA damage and fragmentation) were observed by terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL), and significant increases in Bax and decreases in Bcl-2, micro-vessel density (MVD), vascular endothelial growth factor (VEGF) and proliferating cell nuclear antigen (PCNA) were observed by immunohistochemistry ( P < 0.01). These experimental results indicate that in vivo tumor growth can be effectively inhibited by nsPEF, which activate two targets, apoptosis initiation and angiogenesis inhibition.

This paper describes a highly controllable method to generate hollow calcium alginate microfibers using a double co-axial flow microdevice. The microdevice was fabricated by concentric assembly of two modules; each module consisted of a shortened cone-pulled glass capillary embedded in a polymethylmethacrylate fluidic block. Using this microdevice, cylindrical hollow calcium alginate microfibers with either straight or helical inner walls were stably and continuously generated. The radii of the hollow microfibers were not arbitrary, and in fact, the ratio of the outer to inner diameter was inversely correlated with the combination of core flow rate and the first sheath flow rate. The relationships between the geometrical features of the helix and the flow rates were also analyzed. The helical pitch and the spiral radius of the helical hollow microfibers were strongly influenced by the second sheath flow rate. Finally, guidelines for generating highly controllable straight and helical hollow microfibers and fabricating a seamless flow connector using this microfluidic device are suggested.

Multi-walled carbon nanotubes with excellent electrical properties and high aspect ratios can reduce the high field strength required to kill cancer cells in vitro with nanosecond pulsed electric fields. For the first time, this article systematically and comprehensively evaluates the effects of various parameters of nanosecond pulsed electric fields combined with multi-walled carbon nanotubes on cell viability. The effects of field strength, E (2-10 kV/cm); pulse width, τ (100-500 ns); and pulse number, N (5-260) on the viability of A375 human skin cancer cells in the presence of multi-walled carbon nanotubes are studied using the Cell Counting Kit 8 assay. Based on a logistic model, the relationship between cell viability and various parameters is obtained using 1-dimensional nonlinear fitting. The results show a sigmoid-type variation in cell viability with field strength, pulse width, or pulse number. Multivariate scaling analysis shows that the relationship between cell viability and the pulse energy density σE2 τN can be described as a sigmoid type. The introduction of multi-walled carbon nanotubes does not affect the above rules but significantly enhances the killing effect of nanosecond pulsed electric fields, which could effectively improve the electrical safety of nanosecond pulsed electric fields for the treatment of tumors.

Tumor cell apoptosis by using nanosecond pulsed electric fields (nsPEF) has a great potential in clinical tumor treatment. It is difficult to find the appropriate parameters of nsPEF which can induce substantial apoptotic tumor cells because of selectivity between apoptosis and parameters of pulse number and pulse duration. To obtain the optimum parameters of nsPEF which can achieve large proportion of apoptotic tumor cells, nsPEF with different parameters (Electric field intensity of 45 kV/cm; pulse durations are 50, 100 and 200 ns respectively; pulse numbers are 10, 30, 60 and 80, respectively; repetition frequency of 1 Hz) were performed on SKOV3 cells. The experimental results of both Annexin-V/PI staining and DNA ladder gel electrophoresis indicated that apoptosis of tumor cells was pulse duration and number-dependent. With constant electric field intensity of 45 kV/cm, nsPEF of 100 ns duration and 30 pulses caused substantial tumor cell apoptosis with few necrotic cells and maximum caspase-3 activation.

High-throughput sequencing-based metagenomic approaches were used to comprehensively investigate ultraviolet effects on the microbial community structure, and diversity and abundance of antibiotic resistance genes (ARGs) and mobile genetic elements (MGEs) in biologically treated wastewater. After ultraviolet radiation, some dominant genera, like Aeromonas and Halomonas, in the wastewater almost disappeared, while the relative abundance of some minor genera including Pseudomonas and Bacillus increased dozens of times. Metagenomic analysis showed that 159 ARGs within 14 types were detectable in the samples, and the radiation at 500 mJ/cm(2) obviously increased their total relative abundance from 31.68 ppm to 190.78 ppm, which was supported by quantitative real time PCR. As the dominant persistent ARGs, multidrug resistance genes carried by Pseudomonas and bacitracin resistance gene bacA carried by Bacillus mainly contributed to the ARGs abundance increase. Bacterial community shift and MGEs replication induced by the radiation might drive the resistome alteration. The findings may shed new light on the mechanism behind the ultraviolet radiation effects on antibiotic resistance in wastewater.

In order to study the apoptosis-induction effects of exponential decay nanosecond pulsed electric fields (EDnsPEF) in vivo, tumor models in 20 female BALB/c nude mice were established by inoculating them with human melanoma cells A375. These mice were randomly divided into treated group (exposed to EDnsPEF with intensity of 20 kV/cm and duration of 300 ns) and control group equally. Twenty days later, tumor growth in the treated group was effectively inhibited (P

We studied the influence of various parameters of high-frequency nanosecond pulse bursts on the strength of rabbit muscle contractions. Ten unipolar high-frequency pulse bursts with various field intensities E (1 kV/cm, 4 kV/cm, and 8 kV/cm), intraburst frequencies f (10 kHz, 100 kHz, and 1 MHz), and intraburst pulse numbers N (1, 10, and 100) were applied using a pair of plate electrodes to the surface skin of the rabbits' biceps femoris, and the acceleration signal of muscle contraction near the electrode was measured using a 3-axis acceleration sensor. A time- and frequency-domain analysis of the acceleration signals showed that the peak value of the signal increases with the increasing strength of the pulse burst and that the frequency spectra of the signals measured under various pulse bursts have characteristic frequencies (at approximately 2 Hz, 32 Hz, 45 Hz, and 55 Hz). Furthermore, we processed the data through multivariate nonlinear regression analysis and variance analysis and determined that the peak value of the signal scales with the logarithm to the base 10 of EN x, where x is a value that scales with the logarithm to the base 10 of intraburst frequency (f). These results indicate that for high-frequency nanosecond pulse treatment of solid tumors in or near muscles, when the field strength is relatively high, the intraburst frequency and the intraburst pulse number require appropriate selection to limit the strength of muscle contraction as much as possible.

This study used 454 pyrosequencing, Illumina high-throughput sequencing and metagenomic analysis to investigate bacterial pathogens and their potential virulence in a sewage treatment plant (STP) applying both conventional and advanced treatment processes. Pyrosequencing and Illumina sequencing consistently demonstrated that Arcobacter genus occupied over 43.42% of total abundance of potential pathogens in the STP. At species level, potential pathogens Arcobacter butzleri, Aeromonas hydrophila and Klebsiella pneumonia dominated in raw sewage, which was also confirmed by quantitative real time PCR. Illumina sequencing also revealed prevalence of various types of pathogenicity islands and virulence proteins in the STP. Most of the potential pathogens and virulence factors were eliminated in the STP, and the removal efficiency mainly depended on oxidation ditch. Compared with sand filtration, magnetic resin seemed to have higher removals in most of the potential pathogens and virulence factors. However, presence of the residual A. butzleri in the final effluent still deserves more concerns. The findings indicate that sewage acts as an important source of environmental pathogens, but STPs can effectively control their spread in the environment. Joint use of the high-throughput sequencing technologies is considered a reliable method for deep and comprehensive overview of environmental bacterial virulence.

In order to comprehensively investigate tetracycline resistance in activated sludge of sewage treatment plants, 454 pyrosequencing and Illumina high-throughput sequencing were used to detect potential tetracycline resistant bacteria (TRB) and antibiotic resistance genes (ARGs) in sludge cultured with different concentrations of tetracycline. Pyrosequencing of 16S rRNA gene revealed that tetracycline treatment greatly affected the bacterial community structure of the sludge. Nine genera consisting of Sulfuritalea, Armatimonas, Prosthecobacter, Hyphomicrobium, Azonexus, Longilinea, Paracoccus, Novosphingobium and Rhodobacter were identified as potential TRB in the sludge. Results of qPCR, molecular cloning and metagenomic analysis consistently indicated that tetracycline treatment could increase both the abundance and diversity of the tet genes, but decreased the occurrence and diversity of non-tetracycline ARG, especially sulfonamide resistance gene sul2. Cluster analysis showed that tetracycline treatment at subinhibitory concentrations (5 mg/L) was found to pose greater effects on the bacterial community composition, which may be responsible for the variations of the ARGs abundance. This study indicated that joint use of 454 pyrosequencing and Illumina high-throughput sequencing can be effectively used to explore ARB and ARGs in the environment, and future studies should include an in-depth investigation of the relationship between microbial community, ARGs and antibiotics in sewage treatment plant (STP) sludge.

This study was conducted to investigate the anti-tumor efficacy of nanosecond pulsed electric fields (nsPEFs) on the mouse with A375-GFP melanoma xenograft in vivo. In vivo fluorescence image analysis system was used in this study to evaluate the effects of nsPEFs on human melanoma A375 cell xenograft. On the Day 90 af ter pulse delivery, the skin that had contained A375 cell xenograft was surgically excised and pathologically evalua ted. The changes of scar were recorded by digital camera. The experiment revealed that significant changes in fluorescence value trend and amplitude were found in the treated group from those in the control group. The fluorescence of tumor in the treated group decreased mostly 48 h after the treatment and completely disappeared 10 d after the treatment, while that in control group was increased gradually. Surgical excision of the area confirmed a complete pathologic response. Within a few days after the nsPEFs treatment, a hard scab formed at the treatment region. The scab fell off by the end of the second week. As time went on, the scar gradually became faded and all xenograft tumors were disappeared without recurrence. From the experiment, we learn that nsPEFs can bring good therapeutic effect. It may provide a new approach for the clinical treatment of superficial tumors.

This paper is to investigate the apoptosis effect of ovarian cancer SKOV3 cells induced by nanosecond plused electric fileds (nsPEFs) and to study its influence on Fas-mediated apoptosis. SKOV3 cell were exposed to the 45kV/cm of field intensity, 30 pulses, and 50ns, 100ns, and 200ns of pulse width, respectively. Flow cytometry were used to assay apoptosis. Agarose gel electrophoresis was used to detect DNA ladder. Real time PCR (RT-PCR) and Western blot analysis were used to measure the expression level of Fas, FasL, caspase-8 and Bid. Flow cytometry results revealed that the late apoptosis rates and (or) necrosis were significantly higher than those in control group (3.03% +/- 0.57%) (P0.05), with apoptosis rates and (or) necrosis being (18.31 +/- 0.65%), (45.55% +/- 3.71%), (47.47% +/- 7.01%) in the groups of 50ns, 100ns, 200ns, respectively. A typical DNA ladder pattern of internucleosomal fragmentation was observed in the groups of 50ns and 100ns, but not clear in the 200ns group. RT-PCR results revealed that the mRNA expression of Fas, FasL, caspase8 and Bid were significantly increased in groups of 50ns, 100ns, but significantly decreased in group of 200ns (P0.05). Meanwhile, Western blot analysis demonstrated that the Fas, FasL, Caspase-8 and Bid expression were significantly higher in groups of 50ns, 100ns, but significantly lower in group of 200ns (P0.05). It indicated that 45kV/cm, 50ns, 100ns nsPEFs could induce apoptosis in ovarian cancer SKOV3 cells and activate Fas-mediated apoptosis pathway.

This paper studies the apoptosis of human ovarian carcinoma cell Line (SKOV3) induced by the nanosecond pulsed electric field (10kV/cm, 100ns, 1 Hz) and its effect on intracellular calcium concentration ([Ca2+]i). These cells were doubly marked by Annexin V-FITC/PI, and the apoptosis rate was analyzed with flow cytometry. After AO/EB staining the morphological changes were observed under fluorescent microscope, and their ultrastructural changes were observed under scanning electron microscope (SEM). With Fluo-3/AM as calcium fluorescent marker, laser scanning confocal microscope (LSCM) was used to detect the effect of nsPEF on [Ca2+]i and the source of Ca2+. The results showed that the early apoptosis rate of the treatment group was (22.21+/-2.71)%, significantly higher than that of the control group (3.04+/-0.44)% (P0.01). The typical features of apoptotic cell have been observed by fluorescent microscope and SEM. It is proved that nsPEF can induce apoptosis of SKOV3 cells and result in distinct increase in [Ca2+]i (P0.01), which was independent of extracellular calcium concentration (P0.05). Since nsPEF can penetrate cell membrane due to its high frequency components, one of the mechanisms of nsPEF-induced apoptosis may be that activating intracellular calcium stores can increase the [Ca2+]i, and consequently, the apoptotic signal pathway can be induced.