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The accurate understanding of the origin of overpressure is the basis of formation pressure research and the core work of determining the distribution of formation pore pressure in drilling design. The deep water area of Baiyun Sag in the Pearl River Mouth Basin in the northern margin of the South China Sea has been proved to be a hydrocarbon rich depression. In recent years, overpressure has been encountered in the middle and deep layers, but the geological origin of the overpressure in the deep water area are still unclear. Therefore, the pore pressure profile of the Baiyun Sag was evaluated using the data of drilling and seismic velocity, and the relationship between overpressure and the generation mechanism was established. Most of the surrounding and shallow strata of Baiyun Sag show normal pressure, while the middle and deep strata generally show overpressure, with the maximum pressure coefficient up to 1.55. The overpressure zone mainly develops from the middle of Zhujiang Formation to the upper member of Enping Formation. The mudstone resistivity and density values of the two typical Wells deviated from the normal trend. The density showed a constant trend with the increase of depth, while the resistivity showed a certain degree of reversal. The upper layer of the overpressure zone showed abnormally high resistivity values, corresponding to the overgland and transition zone formed by high carbonate content. There is no obvious increase of porosity in the overpressured sandstone strata of Baiyun sag, which does not have the characteristics of undercompaction. The velocity in the overpressure section of the two Wells varies greatly, and the density is basically unchanged or slightly decreased. It is concluded that the overpressure is caused by fluid expansion from hydrocarbon-generation. The large-scale and long-term fluid expansion caused by hydrocarbon generation and expulsion of source rocks provides the power source for the formation of overpressure in Baiyun sag. The distribution of effective source rocks has a controlling effect on the distribution range of overpressure. The tight sandstone strata in the Zhuhai, Wenchang and Enping formations become the cover layer of the overpressure system in the longitudinal direction.

Microvascular decompression (MVD) is the first choice of surgery for hemifacial spasm (HFS). MVD surgery for vertebral artery (VA)-associated HFS is more difficult than for non-VA-associated HFS. There is controversy about the cure rate and complication of MVD for HFS in previous studies. We searched PubMed, Web of Science, and Embase for relevant publications. Based on the search results, we compared the outcomes of MVD for VA-associated HFS and non-VA-associated HFS. At the same time, we analyzed spasm-free rates and the complications and assessed the relationship between VA-associated HFS and gender, left side, and age. For analysis, six studies that included 2952 patients in the VA-associated group and 604 in the non-VA-associated group were selected. The effective rate of MVD was not significantly different between both groups (OR = 1.16, 95% CI 0.81-1.67, P = 0.42). Compared to non-VA-associated group, the transient complications (OR = 0.64, 95% CI 0.46-0.89, P = 0.008) and permanent complications (OR = 0.28, 95% CI 0.15-0.54, P = 0.0001) occurred more frequently in VA-associated group. The rate of hearing loss was significantly higher in VA-associated HFS than non-VA-associated HFS (OR = 0.35, 95% CI 0.19-0.64, P = 0.0007); the facial paralysis after operation was not significantly different between both groups (OR = 1.25, 95% CI 0.91-1.72, P = 0.17). There were older patients (WMD = 3.67, 95% CI 3.29-4.05, P 0.00001) and more left-sided HFS (OR = 0.23, 95% CI 0.19 - 0.29, P 0.0002) in the VA-associated HFS group than non-VA-associated HFS group, while the non-VA-associated HFS group was female-dominated (OR = 1.58, 95% CI 1.32 - 1.89, P 0.00001). Both groups achieved good results in MVD cure rates. In VA-associated HFS, the complication rate of decompression and the rate of hearing loss after operation were higher than in non-VA-associated HFS, but the facial paralysis after operation was similar in both groups, and most complications were transient and disappeared during follow-up. VA-associated HFS is more prevalent in older adults, less prevalent in women, and more predominantly left-sided. More clinical studies are needed to better compare the efficacy and complication of MVD between both groups.

Liquid biopsy techniques based on deep sequencing of plasma cell-free DNA (cfDNA) could detect the low-frequency somatic mutations and provide an accurate diagnosis for many cancers. However, for brain gliomas, reliable performance of these techniques currently requires obtaining cfDNA from patients' cerebral spinal fluid, which is cumbersome and risky. Here we report a liquid biopsy method based on sequencing of plasma cfDNA fragments carrying 5-hydroxymethylcytosine (5hmC) using selective chemical labelling (hMe-Seal). We first constructed a dataset including 180 glioma patients and 229 non-glioma controls. We found marked concordance between cfDNA hydroxymethylome and the aberrant transcriptome of the underlying gliomas. Functional analysis also revealed over-representation of the differentially hydroxymethylated genes (DhmGs) in oncogenic and neural pathways. After splitting our dataset into training and test cohort, we showed that a penalized logistic model constructed with training set DhmGs could distinguish glioma patients from healthy controls in both our test set (AUC = 0·962) and an independent dataset (AUC = 0·930) consisting of 111 gliomas and 111 controls. Additionally, the DhmGs between gliomas with mutant and wild-type isocitrate dehydrogenase (IDH) could be used to train a cfDNA predictor of the IDH mutation status of the underlying tumour (AUC = 0·816), and patients with predicted IDH mutant gliomas had significantly better outcome (p = 0·01). These results indicate that our plasma cfDNA 5hmC sequencing method could obtain glioma-specific signals, which may be used to non-invasively detect these patients and predict the aggressiveness of their tumors.

Comprehensive investigations on the incidence and prognosis of pituitary tumors are still lacking. The present study aims to summarize the incidence, demographics, and survival outcome of pituitary adenoma on a population-based level. This study includes all pituitary adenomas reported in the Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2016 in the United States. Extensive clinical and demographic characteristics were extracted and submitted to group comparisons. The standardized incidence rate was calculated and stratified by year at diagnosis, age/sex and age/treatment groups. The Kaplan–Meier analysis and multivariable regressions were performed to identify the factors associated with overall survival. A total of 47,180 pituitary tumors were identified, including 47,030 typical adenomas, 111 uncertain behavior pituitary adenomas, and 39 pituitary carcinomas. The overall standardized incidence rate was 4.8 cases per 100,000 person-years and the annual incidence rate continually trended upwards, with a peak seen in 2015. We noticed a bimodal age-related distribution in females and a unimodal distribution in males. In the multivariate regression analysis, the factors associated with prolonged survival included typical adenoma, younger age, and smaller tumor size. Whereas, black and male patients had worse overall survival. Our study provides a reliable estimate on the incidence of pituitary adenoma and confirms that the annual standardized incidence rate is increasing. Pituitary adenomas have a satisfactory long-term prognosis and age, tumor size, and tumor subtypes are related to overall survival. Though statistically significant, our inferential findings should be constrained within the limitations of SEER database.

Pituitary adenoma (PA) is a benign intracranial neoplasm originated from pituitary gland. Surgery is the first-line therapy for most of PAs, but lead to unsatisfactory prognosis in some cases. Tetrandrine (Tet) has anticancer effect on some cancers. However, growth inhibition effect on PA is unknown. To elucidate the inhibitory effect of Tet on the growth of PA and its potential mechanisms, we validated the in vitro and in vivo anti-PA effect of Tet and illustrated the cellular and molecular alterations by confocal microscopy observation, flow cytometry, and RNA interference. Tet inhibited PA cell growth in vitro and tumor progression in vivo. Tet induced autophagy and apoptosis in a dose-dependent manner. Low dosage (1.25 μM) of Tet induced PA cell autophagy by down-regulation of MAPK/STAT3 signal. While, higher dosage (5.0 μM) of Tet partially induced PA cell death through caspase-dependent apoptosis. Autophagy inhibitors enhanced Tet-induced caspase activity and apoptotic cell death. These findings demonstrated that Tet has anti-PA effect by inducing autophagy and apoptosis through MAPK/STAT3 signaling pathway attenuation and autophagy inhibition might enhance its anti-PA effect, indicating that Tet (or combined with autophagy inhibitor) is a potential therapeutic regimen for PAs.

Pigmented tumors are rare neoplasm of central nervous system. Melanocytic tumor, including primary and metastatic lesions, is the most common type. Owing to the rarity, the differential diagnosis of pigmented tumors and clinical management of melanocytic tumor remain challenge. Therefore, focusing on melanocytic tumors, the clinical, radiological, histopathological features and treatment outcomes were presented and analyzed in this study. We identified 22 melanocytic tumors, 2 melanotic medulloblastomas, 2 melanotic ependymomas and 1 melanotic schwannoma. Compared with metastatic melanocytic tumors (MMTs), primary melanocytic tumors (PMTs) were characterized by younger age (36.11 ± 17.96 vs. 51.69 ± 12.58 years, p = 0.0262), lower possibility to be multiple lesions (11.1%vs. 61.5%, p = 0.0306), higher proportion of hypointensity on T2-weighted images (66.7% vs. 15.4%, p = 0.0260) and higher frequency in black appearance (77.8% vs. 23.1%, p = 0.0247). During the follow-up, 4 PMTs and 11 MMTs (71.4%) experienced tumor progression. PMTs had better prognosis than MMTs that progression-free survival (PFS) rate of PMT was 50.0% but decreased to 23.1% for MMTs at 12 months (p = 0.0123). Cox proportional hazards regression revealed that multiplicity of tumor was an independent predictor for PFS. None of patient with multiple tumors was in PFS after 12 months’ follow-up whereas PFS rate was 40.5% for single tumor (p = 0.0002). In conclusion, radiological appearances, especially hypointensity on T2-weighted images, might be an indication for PMT. MMTs are more likely to be multiple intraparenchymal masses in elder patients located in supratentorial region. Current treatments included operation, radiotherapy and chemotherapy are not competent to control tumor progression and other therapeutic modalities are urgently needed.

Aiming at the problem of insufficient data acquisition for steep carbonate outcrops, we used unmanned aerial vehicle oblique photogrammetry to quantitatively evaluate Jiantianba outcrops from a global perspective. This method can quickly and flexibly acquire, process and interpret outcrop data, establish the three-dimensional digital outcrop model and quantitative reservoir geological knowledge database. Through the fine analysis and comparative study of multiple outcrop sections, we use lithofacies combination, hierarchical interface, sequential indicator stochastic simulation and multiple-point geostatistical simulation methods to establish a three-dimensional multi-point statistical model of the outcrop area. The results show that the model of the Jiantianba carbonate outcrop has three-dimensional coordinates that correspond to oblique photograph image data, allowing for both the accurate location of any point and the measurement of the rock body, and thus providing a base for studying the stratigraphic architecture of the outcrop. Through fine-scale geological and statistical analyses of the geological parameters of three geologic sections, we established a database and model of a typical outcrop, including the types, continuity and scale of lithology, as well as different lithological combinations and the geological evolution of the region. And we established a geological model and quantitative geological database via sequential indicator simulation, using virtual well location, lithological combination, stratigraphic correlation, three-dimensional stratigraphic and lithological models of a typical outcrop. Subsequently, we analyzed the training images of different microfacies based on these models combined with the outcrop geometry. Finally, we established a three-dimensional geological model of reef–shoal facies that is more in line with our current understanding of the geology of the outcrop area by multi-point geostatistical simulations.

Glioma initiating cells (GICs), also known as glioma stem cells, display the capacity to recapitulate the functional diversity within the tumor. Despite the great progress achieved over the last decades, defining the key molecular regulators of GICs has represented a major obstacle in this field. In our study, data from The Cancer Genome Atlas database illustrated a relationship between C-X-C motif chemokine receptor 4 (CXCR4) expression and the survival of glioma patients. Mechanistically, we further indicated that CXCR4 mediated the upregulation of Kruppel like factor 5 (KLF5), a zinc-finger-containing transcription factor, to facilitate the proliferation of GICs. What's more, CXCR4 also enhanced the chemoresistance through KLF5/Bcl2-like 12 (BCl2L12) in glioma. The elevated expression of KLF5 and BCL2L12 induced by CXCR4 was dependent on phosphoinositide 3-kinases (PI3K)/serine/threonine kinase (AKT) signaling. Importantly, combined application of temozolomide and a CXCR4 inhibitor efficiently reversed CXCR4 mediated drugs resistance and improved anticancer effects in vivo. Collectively, our findings confirmed that CXCR4 promoted GICs proliferation via the KLF5/BCL2L12 dependent pathway, which may enrich the understanding of GICs and help drive the design of efficacious therapeutic strategies.

As the controlling effect of complex lithofacies of lacustrine mixed fine-grained rocks on the shale oil sweet spot remains unclear, core, outcrop, general logging, nuclear magnetic resonance (NMR) logging, testing, and production data were used to study the types, combination pattern, and genesis of lithofacies architectures of lacustrine mixed fine-grained rocks in the study area by lithofacies hierarchy analysis, X-ray fluorescence (XRF) logging, UAV, and 3D geological modeling. The research shows that: 1) According to lithology and sedimentary structure, the mixed fine-grained rocks can be divided into 13 lithofacies types of different origins in 5 sub-categories and 2 categories. 2) UAV photography was combined with a traditional field survey to characterize the 3D spatial distribution of lithofacies architecture of the Lucaogou Formation on the outcrop, and it is found that the lithofacies architecture patterns of mixed fine-grained rocks include three types: gradual change type, abrupt change type, and special type. The gradual change type with higher sand development degree and symmetrical lithofacies architecture has a high quality reservoir with dissolution pores, and is mixed beach-bar sand in the mixed zone. It is high in development degree and often appears as several similar cycles stacking over each other. The abrupt change type can be subdivided into two sub-types, asymmetric and smaller in reservoir thickness. It is very high in development degree and often comes in several similar cycles. The special type belongs to thick clastic rock relatively independent in the mixed fine-grained rocks with a high development degree of sand. The sand is a higher quality reservoir with properties of tight reservoir. It often appears as stacking of single cycle sand. 3) The different lithofacies architectures in the mixed fine-grained rocks have significant differences in distribution. The gradual change type is mainly composed of mudstone, dolomitic siltstone, and sandy dolomite, dolomitic siltstone, and mudstone, and appears in lenticular shape overlapping with each other on the plane. The abrupt change type is made up of felsic siltstone, dolomitic siltstone, sandy dolomite, and mudstone, and appears as isolated thin layers on the plane. The special type is mainly composed of mudstone and felsic siltstone, and mudstone, and turns up as lenses of different sizes on the plane.

Background Solitary fibrous tumor (SFT) and hemangiopericytoma (HPC) are rare mesenchymal tumors in the central nervous system with a high tendency to relapse, having a significant impact on quality of life (QoL). Due to the rarity of intracranial SFT/HPC, the prognostic factors and optimal treatment remain to be elucidated. Meanwhile, quality of life in patients with intracranial SFT/HPC is seldomly concerned. Thus, we aim to survey about the quality of life and underline some aspects demanding concern in intracranial SFT/HPC treatment through summarizing our case series in recent ten years. Methods Patients with intracranial SFT/HPC who underwent surgical resection from January 2009 to June 2019 were included in the study. Clinical features, such as age, gender, and resection extent, were collected. The EuroQol Five Dimensions Questionnaire (EQ-5D) was used to assess the patients’ quality of life (QoL). Prognosis factors related to progression-free survival (PFS) and overall survival (OS) were also evaluated. Results Thirty-six patients with a mean follow-up period of 61.6 months (range 13–123 months) were included in this study. Sixteen (44.4%) patients achieved gross total resection (GTR). Fourteen patients (38.9%) with tumor progression experienced adjuvant radiotherapy (11.1%) or Gamma Knife surgery (GKS, 27.8%). According to the 2016 WHO classification, there were 6 (16.7%) grade I SFT/HPC, 11 (30.5%) grade II SFT/HPC, and 19 (52.8%) grade III SFT/HPC. The PFS and OS were 29 months (range 4–96 months) and 38 months (range 4–125 months). The median EQ5D-3 L tariff with or without progression was 0.617 (95% CI 0.470–0.756) and 0.939 (95% CI 0.772–0.977) respectively. Gross total resection (GTR, p = 0.024) and grade I SFT/HPC (p = 0.017) were significantly associated with longer PFS. In multivariate analysis, GTR (HR 0.378, 95% CI 0.154–0.927) and adjuvant therapy (HR 0.336, 95% CI 0.118–0.956) result in significantly longer PFS in patients with SFT/HPC. Conclusions Patients underwent GTR and adjuvant therapy had longer PFS. Similarly, patients with lower WHO grade had relatively longer PFS. Therefore, GTR is advocated for the treatment of SFT/HPC. And adjuvant therapy such as GKS could be an alternative treatment for patients who underwent STR or with tumor progression. Further, the QoL decreased in patients with tumor progression and metastasis, and more attention is demanded to the QoL of intracranial SFT/HPC patients.

Non-functional pituitary adenomas (NFPAs) are one of the most prevalent pituitary adenoma subtypes. The lack of reliable screening approach for NFPAs for the insidious clinical course usually leads to delays in medical therapy and consequently worse prognosis. Hence, we employed a sequence cohort (patient: control, 6:2) and a validation cohort (patient: control, 22:8) to develop a serum exosomal miRNA profile-based method for NFPA screening and prognosis prediction. We found that a total of 1,395 kinds of human miRNA were detected. Compared with healthy donors, 18 up-regulated and 36 down-regulated miRNAs showed significant expression alterations in NFPA patients. Target genes of differentially expressed miRNAs are mainly enriched in axonogenesis and cancer-associated terms. After validation, hsa-miR-486-5p, hsa-miR-151a-5p, hsa-miR-652-3p_R+1, and hsa-miR-1180-3p were promising biomarkers for NFPA, in which miR-486-5p was the most competent one. After a median of 33 months of prospective follow-up, exosomal hsa-miR-486-5p also was an efficient predictive biomarker for progression or relapse of NFPAs. By protein-protein interaction network construction of hsa-miR-486-5p targeted genes, the core modules revealed a high possibility that exosomal hsa-miR-486-5p regulated tumor progression by epigenetic regulation of MAPK signaling pathways. In conclusion, exosomal hsa-miR-486-5p, hsa-miR-151a-5p, hsa-miR-652-3p_R+1, and hsa-miR-1180-3p are candidate biomarkers for diagnosis and screening of NFPAs. More importantly, prospective follow-up reveals that hsa-miR-486-5p can be regarded as a significant predictor for prognosis of NFPAs.

The rhesus macaque is a prime model animal in neuroscience. A comprehensive transcriptomic and open chromatin atlas of the rhesus macaque brain is key to a deeper understanding of the brain. Here we characterize the transcriptome of 416 brain samples from 52 regions of 8 rhesus macaque brains. We identify gene modules associated with specific brain regions like the cerebral cortex, pituitary, and thalamus. In addition, we discover 9703 novel intergenic transcripts, including 1701 coding transcripts and 2845 lncRNAs. Most of the novel transcripts are only expressed in specific brain regions or cortical regions of specific individuals. We further survey the open chromatin regions in the hippocampal CA1 and several cerebral cortical regions of the rhesus macaque brain using ATAC-seq, revealing CA1- and cortex-specific open chromatin regions. Our results add to the growing body of knowledge regarding the baseline transcriptomic and open chromatin profiles in the brain of the rhesus macaque., Non-human primates share many features with humans and are an important animal model in neuroscience. Here, the authors present a comprehensive transcriptomic and open chromatin atlas of the rhesus macaque brain.

Although well-documented from pathological aspect, the clinical features and outcomes of acromegaly with mammosomatotroph (MSA) and mixed somatotroph-lactotroph adenoma (MSLA) are seldom reported. Thus, in this study, we analyzed and reported the clinical data about MSAs and MSLAs. We retrospectively reviewed medical records of patients with acromegaly in our institution during 2008–2017. Growth hormone (GH)-secreting adenomas were categorized into pure somatotroph adenoma (PSA), MSA and MSLA based on inclusion and exclusion criteria. Clinical information and treatment outcomes during follow-up were analyzed by univariate and multivariate methods. Among 94 patients within this cohort, PSAs, MSAs, and MSLAs accounted for 53, 28 and 13 cases, respectively. MSAs often had smaller size, lower frequency of cavernous sinus invasion and higher gross total resection (GTR) rate. MSLAs were characterized by bigger tumor size, higher frequency of preoperative hyperprolactinemia, and lower GTR rate. Thus, MSLAs had worse long-term biological remission rate than MSAs and PSAs (15.4% vs. 50.0% and 26.4%, p = 0.0371). Gender (male, OR = 0.784, p = 0.011) and tumor volume (OR = 0.784, p = 0.020) were independent predictors for long-term biological remission in binary logistic regression. Subgroup analyses indicated that postoperative nadir GH level (GH-7, HR = 1.242, p = 0.001) was the only risk factor for tumor recurrence for patients with GTR. Our results provide valuable insights into clinicopathological features of acromegaly. MSAs were relatively smaller lesions with better prognosis. MSLAs were more aggressive with massive size, invasiveness and preoperative hyperprolactinemia. Tumor size and GH-7 were significantly associated with biological remission and tumor relapse after GTR, respectively.

Strong heterogeneity, poor pay reservoir connectivity, and complex micro-pore structure are the reasons behind the high difficulty and low accuracy in the productivity evaluation of tight sandstone gas reservoirs. This paper utilized various well logging and mud logging curve data, summarizes the typical curve type, and made use of a mathematical method to form quantitative characterization. Additionally, a logging curve evaluation method is proposed based on the test of production capacity. The total hydrocarbon curve can be divided into six types as shown by the results: box shape, half box shape, upright triangle, inverted triangle, sawtooth shape, single peak, etc. The above is closely related to the level of oil and gas in the reservoir layer. Six types of total hydrocarbon curve can be quantified by amplitude, relative centroid, relative sawtooth, variance, and the parameter value of the autocorrelation function. The box-shaped total hydrocarbon gas logging curve is full and has a large scale. The half box-shaped total hydrocarbon gas logging curve peak scale is significantly smaller than that of the reservoir thickness. The triangularly-shaped total hydrocarbon gas logging curve may either be an upright or inverted triangle. The sawtooth-shaped total hydrocarbon gas logging curve has high and low tendencies that show a number of spikes. Single peak-shaped total hydrocarbon gas logging curve is small with a single peak. There is a good relationship between the six kinds of total hydrocarbon gas logging curve and the tight sandstone gas reservoir production capacity. The high and middle gas pay layers are mainly box-shaped and triangular, whereas the lower production layer is half box-shaped, triangular, and has a zigzag pattern. However, the low gas pay layers mainly possess a sawtooth pattern, while the non-production layer is mainly single peak in shape. The comprehensive interpretation of the total hydrocarbon gas logging curve and log resistivity curve can more accurately distinguish the production capacity of tight sandstone gas reservoirs. Finally, the quantitative model is used for automatic interpretation. Through data verification and analysis, it is found that the coincidence rate of the production gas pay layer is 80.95%, whereas the coincidence rate of production capacity is 78.05%. It is proven by practice that the gas formation capacity of tight sandstone gas reservoirs can be predicted based on the logging and mud logging well curve shapes. Keywords: Method of total hydrocarbon gas mud logging curve, Tight sandstone gas, Reservoir, Fracturing production well capacity

Although pituitary adenomas (PAs) are regarded as benign neoplasm, efficient postoperative management of PAs, especially invasive PAs, is still a major challenge for neurosurgeons. Thus, in order to verify the effect of postoperative surveillance alone for invasive PAs and identify helpful predictive factors of relapse after initial surgery, a series of 107 cases of surgically gross-totally resected invasive PAs were retrospectively investigated. With regarded to pituitary function, the preoperative incidence of hypothyroidism was higher than that of hypoadrenocorticism and hypogonadism (66.4% vs. 31.8% and 29.9%; p 0.001). Tumors extended into sphenoid sinus or cavernous sinus may be less likely to develop hypoadrenocorticism or hypogonadism. Postoperative relapse was found in 35 cases (32.7%) during a median follow-up of 27 months. The overall relapse rates were 12.3, 28.9 and 38.4% at 1, 3 and 5 years, respectively. Tumor size was the exclusive independent risk factor for relapse. Higher relapse rates presented in large invasive PAs (more than 3.45 cm) were 24.5, 48.9 and 59.2% at 1, 3 and 5 years, respectively. In conclusion, preoperative larger tumors shared significantly higher risk of relapse after initial surgical total resection. Due to the relatively high relapse rate, close surveillance should be executed in strict rotation in postoperative management of gross-totally resected invasive PAs. Moreover, special attention should be payed to tumors with diameter of more than 3.45 cm for more than half of them relapsed in 5 years.

Backgrounds Macaca fascicularis (M. fascicularis) is a primate model organism that played important role in studying human health. It is vital to better understand the similarity and differences of gene regulation between M. fascicularis and human. Current comparative study of gene regulation between the two species are limited by low quality of gene annotation and lack of regulatory element data on M. fascicularis genome. Results In this study, we improved the M. fascicularis gene annotation with 57 gene expression data from multiple tissues and, more importantly, a manual curation procedure. The new annotation enabled us to map gene expression and identify gene location more accurately. Conclusions Comparing with human gene expression data from the same cell types, we characterized the evolution of expression patterns of homologous genes. Electronic supplementary material The online version of this article (10.1186/s12864-018-5183-y) contains supplementary material, which is available to authorized users.

Giant prolactinomas represent a rare entity of pituitary tumors so that the management of these patients is still a prevalent challenge at present. Paying special attention to the treatment strategy and outcomes, we presented a large series of 42 cases looking forward to share our understanding and experience in management of these patients. Male patients accounted for 71.4% of this series and were relatively younger (35.70±2.42 vs. 52.00±3.55 years, p=0.0011) and harbored bigger tumors (14.57 vs. 7.74 cm3, p=0.0179) compared to females. Almost all of these tumors showed suprasellar extension (97.6%) and cavernous sinus invasion (92.9%). Dopamine agonist represented an efficient method to control PRL concentrations (98.8%) and reduce tumor burdens (81.2 %). PRL normalization was detected in 13 out of the 27 patients initially treated with bromocriptine (BRC) whereas none of the 14 patients with first-line operation gained a normalization of PRL concentration after surgery. Although there was no reliable predictor of tumor response, First PRL reduction was a predictive criterion for the nadir PRL level during the long-time period of follow-up for first-line bromocriptine treatment. In conclusion, patients with giant prolactinomas did not gain more benefits from initial surgery. Dopamine agonist (BRC) should be first-line treatment for giant prolactinomas whereas operation merely served as a remedy for acute compression symptoms and dopamine agonist resistance. Consecutive monitoring of serum PRL levels in the early stage of initial BRC treatment is useful for evaluation of therapeutic effect and further therapeutic decision.

Objective Atypical pituitary adenomas were relatively more malignant lesions defined by WHO criteria. However, not all of them show clinically aggressive behavior. Thus, the current WHO criteria of atypical adenoma didn’t seem to be enough to distinguish clinically aggressive adenoma. Therefore, we would like to identify other clinical factors in a cohort of atypical pituitary adenomas to a better identification of clinical aggressiveness. Patients and Methods In order to verify predictors of clinically aggressive phenotype among atypical pituitary adenomas, we retrospectively analyzed the clinical characteristics and therapeutic outcomes of consecutive 49 cases. Results Totally, 26 cases were identified as clinically aggressive pituitary adenoma. Clinically aggressive lesions were more likely to be functional (46.2% vs. 17.4%, p = .0388) and be detected in males (65.4% vs. 21.7%, p = .0037). Clinically aggressive adenomas also had higher Ki-67 index [5.0 (5.3)% vs. 4.1 (1.3)%, p = .0011] and presented bigger tumor size [11.83 (11.95) cm3 vs. 5.39 (6.08) cm3, p = .0174]. In multivariate analysis, gender (p = .017), functional status (p = .009) and Ki-67 index (p = .024) were independent predictors of clinical aggressiveness. Further analysis revealed that Ki-67 index of more than 4.45% was associated with worse progression-free survival. Conclusions Gender, functional status, tumor size and Ki-67 index ≥ 4.45% were associated with clinical aggressiveness. A clinicopathological classification of pituitary adenomas may be useful to determine who should be under closer radiological follow-up or followed multimodal treatment strategy.

Tumor-associated fibroblasts are the most abundant population in tumor stroma and impact on tumor initiation and progression. However, the biological function of tumor-associated fibroblasts in pituitary adenomas has not been fully elucidated to date. So, this study aims to clarify the function and significance of primary cultured pituitary adenoma-derived tumor-associated fibroblasts on rat pituitary adenoma cells. We identified primary cultured tumor-associated fibroblasts and normal fibroblasts based on the expression of α-smooth muscle actin as well as morphology. Furthermore, we investigated cell biological influences on rat pituitary adenoma cells through indirectly co-culturing tumor-associated fibroblasts with GH3 cells and subcutaneous xenograft model. All sorts of fibroblasts showed positive staining for α-smooth muscle actin. But α-smooth muscle actin and vascular endothelial growth factor highly expressed in invasive pituitary adenoma-derived tumor-associated fibroblasts compared to non-invasive pituitary adenoma-derived tumor-associated fibroblasts and normal fibroblasts. Besides, invasive pituitary adenoma-derived tumor-associated fibroblasts promoted the proliferation of GH3 cells in vitro as well as tumor growth in vivo. Finally, vascular endothelial growth factor was highly expressed in tumor specimens co-injected with invasive pituitary adenoma-derived tumor-associated fibroblasts. Our results suggested that invasive pituitary adenoma-derived tumor-associated fibroblasts displayed apparent growth promotion effects on rat pituitary cells both in vitro and in vivo accompanied by over-expression of vascular endothelial growth factor in invasive pituitary adenoma-derived tumor-associated fibroblasts and tumor specimens.

The purpose of this study was to discuss shape, scale and superimposed types of sandy gravel bodies in sandy-gravel braided distributary channel. Lithofacies analysis, hierarchy bounding surface analysis and subsurface dense well pattern combining with outcrops method were used to examine reservoir architecture patterns of sandy gravel braided distributary channel based on cores, well logging, and outcrops data, and the reservoir architecture patterns of sandy gravel braided distributary channels in different grades have been established. The study shows: (1) The main reservoir architecture elements for sandy gravel braided channel delta are distributary channel and overbank sand, while reservoir flow barrier elements are interchannel and lacustrine mudstone. (2) The compound sand bodies in the sandy gravel braided delta distributary channel take on three shapes: sheet-like distributary channel sand body, interweave strip distributary channel sand body, single strip distributary channel sand body. (3) Identification marks of single distributary channel include: elevation of sand body top, lateral overlaying, “thick-thin-thick” feature of sand bodies, interchannel mudstone and overbank sand between distributary channels and the differences in well log curve shape of sand bodies. (4) Nine lithofacies types were distinguished in distributary channel unit interior, different channel units have different lithofacies association sequence.

Background and Objectives Pay-for-performance is a financial incentive which links physicians’ income to the quality of their services. Although pay-for-performance is suggested to be an effective payment method in many pilot countries (ie the UK) and enjoys a wide application in primary health care, researches on it are yet to reach an agreement. Thus, a systematic review was conducted on the evidence of impact of pay-for-performance on behavior of primary care physicians and patient outcomes aiming to provide a comprehensive and objective evaluation of pay-for-performance for decision-makers. Methods Studies were identified by searching PubMed, EMbase, and The Cochrane Library. Electronic search was conducted in the fourth week of January 2013. As the included studies had significant clinical heterogeneity, a descriptive analysis was conducted. Quality Index was adopted for quality assessment of evidences. Results Database searches yielded 651 candidate articles, of which 44 studies fulfilled the inclusion criteria. An overall positive effect was found on the management of disease, which varied in accordance with the baseline medical quality and the practice size. Meanwhile, it could bring about new problems regarding the inequity, patients’ dissatisfaction and increasing medical cost. Conclusions Decision-makers should consider the baseline conditions of medical quality and the practice size before new medical policies are enacted. Furthermore, most studies are retrospective and observational with high level of heterogeneity though, the descriptive analysis is still of significance.

Hyperprolactinemia is a prevalent endocrine disorder presented in patients with non-functional pituitary adenomas (NFPAs). However, the mechanism involved in hyperprolactinemia in NFPA is not fully illustrated. The current study aims to investigate predictors for hyperprolactinemia in NFPA via analyzing relevant clinical features. Thus, in this study, a cohort of 214 cases with integrated medical records was retrospectively analyzed concerning clinical, pathological, and endocrinological studies before and after surgery.Hyperprolactinemia happened in 93 cases (43.5%). Women (adjust odds ratio [OR] = 3.093; P < .01), age of patients (adjust OR = 0.951; P < .01), and serum free tetraiodothyronine (FT4) level (adjust OR = 0.882; P = .02) were independent predictors for developing preoperative hyperprolactinemia. Tumor size and hypopituitarism had no impact on hyperprolactinemia. During a median follow-up of 43.5 (range, 22-80) months, 83.9% patients with preoperative hyperprolactinemia experienced prolactin (PRL) normalization. Preoperative PRL level (adjusted OR = 1.741, P = .03) was the exclusive predictor for PRL normalization after adjusting for tumor volume, preoperative serum FT4 concentration, and postoperative residual. The PRL normalization rate of patients with lower PRL level (

Primary pilocytic astrocytoma (PA) of the spine is extremely rare and most published case series only include only a few patients. We attempted to explore the clinical features, radiological findings, and treatment outcomes of patients with spinal PA. Sixteen spinal PA patients who were surgically treated in our hospital between April 2008 and June 2018 were included in this retrospective study. An integrative analysis was performed regarding spinal PA patients by extracting from published studies on PubMed. The 16 patients with spinal PA included eight male and eight female patients with a mean age of 29.1 years. Ten cases (62.5%) had masses located in the cervical segments, five (31.3%) had masses in the thoracic segments, and one (6.2%) had masses in the sacral canal. All the patients were treated surgically with 13 gross total resections (GTRs, 81.3%) and three subtotal resections (STRs). The mean follow-up period was 40.4 months. These tumors accounted for a recurrence rate of 37.5% (6 of 16 patients) and no death during the follow-up periods. The influencing factors of recurrence were mainly STR, gene mutation (NF-1 and H2-K27M), and the number of segments involved. The mean recurrence-free survival duration was 19 months. The imaging features of spinal PA are heterogeneous, and the definitive diagnosis requires pathological support. GTR is the standard therapy for spinal PAs, although patients with GTR are still likely to relapse. The regular spinal magnetic resonance imaging follow-ups are required regardless of the resection status. Reoperation is feasible for patients with recurrence.

The major causes of complicated pore structure modalities in sandy conglomerate have not been documented so far. This study incorporates laboratory core analysis, lithofacies classification, qualitative and quantitative analysis of different pore structure modalities to reveal differences in oil displacement efficiency caused by different pore structure modalities. Analytical methods involved in this study include mercury injection data analysis, constant rate mercury penetration, cast thin section observation, scanning electron microscope, and X-ray-CT scanning. Key findings of this work include the following: (1) sandy conglomerate reservoirs are complex and diverse in lithofacies. According to oilfield development with practical, it can be divided into 3 major types, 7 sub-type, 13 tiny types; (2) Different pore structure modals have different features, a rock with single pore structure modality mostly make up of coarse sand grains, has high pore development degree, 3D pore structure in network shape, and good connectivity between pores; a rock with bimodal pore structure consisted of mostly gravel and middle-coarse sandstone, is characterized by particles of 2 grades, well-developed pores, 3D pore structure in sparse network shape, and average connectivity between pores; a rock with multimodal pore structure dominated by gravel, coarse sand, silt sand, or clay is composed of grains of 3 grades, and it has pores in average development degree, star point scattering distribution, and poor connectivity; (3) same lithofacies but different pore structure modalities, and different lithofacies and same pore structure modality are common in sandy conglomerate reservoirs, the former is caused by different grain arrangement modes and differential reformations of various diagenetic process to pore structure, while the latter is a result of particle sorting, roundness, and arrangement mode, etc. sedimentary and diagenetic factors; (4) different pore structure modalities would lead to quite large differences in oil displacement efficiency. In single modal pore structure, the displacement is dominated by network-connected pattern, and result in high efficiency; in bimodal pore structure, the displacement of oil is dominated by star connected pattern which gives average efficiency; in multimodal pore structure, the dominant oil displacement is sporadic scattered pattern and result in poor efficiency on the whole with minor high permeability zone in local part.

Signet-ring cell carcinoma (SRCC) has specific epidemiology and oncogenesis in gastric cancer, however, with no systematical investigation for prognostic genomic features. Here we report a systematic investigation conducted in 1868 Chinese gastric cancer patients indicating that signet-ring cells content was related to multiple clinical characteristics and treatment outcomes. We thus perform whole-genome sequencing on 32 pairs of SRC samples, and identify frequent CLDN18-ARHGAP26/6 fusion (25%). With 797 additional patients for validation, prevalence of CLDN18-ARHGAP26/6 fusion is noticed to be associated with signet-ring cell content, age at diagnosis, female/male ratio, and TNM stage. Importantly, patients with CLDN18-ARHGAP26/6 fusion have worse survival outcomes, and get no benefit from oxaliplatin/fluoropyrimidines-based chemotherapy, which is consistent with the fact of chemo-drug resistance acquired in CLDN18-ARHGAP26 introduced cell lines. Overall, this study provides insights into the clinical and genomic features of SRCC, and highlights the importance of frequent CLDN18-ARHGAP26/6 fusions in chemotherapy response for SRCC., Signet-ring cell carcinoma (SRCC) is a unique type of gastric cancer with no prognostic features. Here, the authors report a CLDN18-ARHGAP26/6 gene fusion in patients with a high signet-ring cell content, poor survival outcomes, and who experience no benefit from platinum/fluoropyrimidines-based chemotherapy.

Intrasellar meningiomas are rare tumors that have the ability to mimic non-functioning pituitary adenomas. The majority of meningiomas are slow-growing and benign, therefore an intrasellar meningioma with malignant histological features is extremely rare. The present study describes the case of a malignant diaphragm meningioma that was controlled through combined chemotherapy, following subtotal surgical resection. The patient's symptoms ceased and no tumor recurrence was detected at the 3-year follow-up. Hormone levels were also observed as normal. Further investigation of similar cases may aid in achieving an accurate pre-operative diagnosis. This would prove particularly beneficial in regards to intrasellar meningiomas due to their specific location and surgical treatment. The present study analyzes the requirement of chemotherapy for the treatment of these unique tumors.

Figure S1. a Summary of the number and source of M. fascicularisâ total RNA-seq samples. Orange: generated by our laboratory; Blue: generated by NHPRTR. b The length and count distribution of new M. fascicularis genome annotation, separately for each chromosome. (PDF 175 kb)

Figure S3. Quantitative measure of the comparison of different annotation versions. a Boxplot of the congruence of Ensemble Macaca fascicularis 5.0.91 annotation, NCBI Macaca fascicularis release 101 and the new annotation (manual) on gene level. b Density of the congruence of Ensemble Macaca fascicularis 5.0.91 annotation, NCBI Macaca fascicularis release 101 and the new annotation (manual) on exon level. (PDF 3225 kb)

Figure S4. Comparability of tissue expression across human and M. fascicularis. a Pearson correlation coefficient matrix of different tissues, left panel shows human, right shows M. fascicularis. Blue means lowest correlation coefficient, orange means highest correlation coefficient. b Functional enrichment of cortex specifically high expressed genes. c Functional enrichment of pituitary and stomach specifically high expressed genes. (PDF 545 kb)

Objective Acromegalic patients with macro- or giant adenomas often had poor prognosis after surgery. Somatostatin analogues (SSAs) show high effectiveness in both tumor shrinkage and serum GH reduction. But the role of SSAs in pre-surgical treatment and the management among macro- and giant adenomas remains controversial. Patients and Methods A total of 100 acromegalic patients with macro- or giant adenomas that underwent surgery in our institution between January 2010 and December 2016 were enrolled in the current retrospective study. The relationships between several potential parameters and surgical outcomes were further analyzed. Results The overall long-term remission rate was 45% accompanied by gross total resection (GTR) rate of 44%. GTR (adjusted OR = 16.346; p = .001) and nadir GH level on OGTT 7 days after surgery (GH-7, adjusted OR = 0.660, p = .039) showed predictive significance for remission after surgery. Tumor size and invasiveness as well as cavernous sinus invasion were risk factors for residual tumor. For invasive macro- or giant adenomas, 6 of 15 patients achieved long-term remission with SSA pre-treatment whereas none of the 18 patients without any preoperative treatment was endocrine controlled. Conclusions Acromegalic patients did not gain more benefits from SSAs pretreatment. But, pre-treatment with SSA could be recommended to patients with invasive macro- or giant adenomas for significant improvement in long-term remission. GTR and GH-7 could be significant predictors in postoperative management of macro- or giant adenomas.

5-Hydroxymethylcytosine (5hmC) is an important mammalian DNA epigenetic modification that has been linked to gene regulation and cancer pathogenesis. Here we explored the diagnostic potential of 5hmC in circulating cell-free DNA (cfDNA) using a sensitive chemical labeling-based low-input shotgun sequencing approach. We sequenced cell-free 5hmC from 49 patients of seven different cancer types and found distinct features that could be used to predict cancer types and stages with high accuracy. Specifically, we discovered that lung cancer leads to a progressive global loss of 5hmC in cfDNA, whereas hepatocellular carcinoma and pancreatic cancer lead to disease-specific changes in the cell-free hydroxymethylome. Our proof of principle results suggest that cell-free 5hmC signatures may potentially be used not only to identify cancer types but also to track tumor stage in some cancers.One Sentence SummaryAnalyzing the epigenetic modification 5-hydroxymethylcysoine in circulating cell-free DNA reveals tumor tissue of origin and stages for cancer diagnostics.

Ventricular septal defect (VSD) is a common congenital heart disease. Open surgical repair with cardiopulmonary bypass (CPB) and sternotomy is the classic treatment. Percutaneous device closure is a minimally invasive alternative in treating selected VSDs, but it is limited by vascular access as well as radiation exposure especially in pediatric patients. Hybrid perventricular device closure of VSDs was designed to combine the advantages of both approaches allowing direct access to the defect without CPB and has gained wider acceptance in recent years. Under transesophageal echocardiography guidance, it could effectively close muscular, perimembranous, and even doubly committed defects. It is a safe and effective option for selected patients with congenital VSDs. In this article, we reviewed the application and results of this technique.

Intraventricular meningiomas are rather rare and only represent a small proportion of all intracranial meningiomas. Data are still limited toward this peculiar entity and surgical resection remains challenging for neurosurgeons. The purpose of present study is to demonstrate clinical features, surgical treatment, and potential risk factors determined long-term prognosis of intraventricular meningiomas. A total of 89 surgically treated and histopathologically confirmed intraventricular meningiomas were identified in our institution from 2008 to 2018. Clinical features, neuroimaging findings, surgical records, and prognosis data were extracted and reviewed retrospectively. Group comparison and recurrence-free survival analysis were performed. Female predominance was well established with a sex radio of 2.1:1. Raised intracranial pressure and decline of visual acuity were 2 chief symptoms that patients generally complained of. Preoperative magnetic resonance imaging (MRI) scans were performed in all patients and there was a trend toward lateral ventricular meningiomas were larger in size than others (P = .07). Superior parietal lobule and temporal approach were widely adopted and lateral/4th ventricular meningiomas were more easily to acquire total tumor resection as compared with 3rd ventricular meningiomas (P = .03). After an average follow-up of 57.3 months, 6 patients experienced recurrence of disease in our series. Individuals with subtotal resection (P

This paper discusses the overall distribution characteristics of alluvial fan in the Triassic Lower Karamay Formation, Yizhong Area, the Karamay Oilfield, with core, outcrop, logging and seismic data. On this basis, the shapes, sizes and stacking patterns of intercalations in different levels and sub-facies are analyzed using the hierarchy bounding surfaces method. In the study area, the Lower Karamay Formation contains (from bottom to top) root fan, middle fan and outer fan deposits, with size-reducing grains, as a complete retrograding sedimentary sequence. The intercalation in the alluvial fan reservoir can be divided into two types: lithological intercalation (fine sediments) and physical intercalation (argillaceous sandstone/conglomerate). Origin, pattern and size of intercalations vary significantly in different sub-facies zones. In particular, the intercalations in root fan are “scattered generally and interlaced locally”, presenting as partially discontinuous screen in a high-permeable network; the intercalations in middle fan are relatively stable intercalations and lateral intercalations, with a higher capacity to shade or screen the seepage; the intercalations in outer fan present as a layered cake, with reservoir bodies mosaic-like along the source and lenticular in perpendicularity to the source that are separated by thick barrier beds, showing the highest capacity of screen. Key words: Karamay Oilfield, Lower Karamay Formation, alluvial fan, intercalation, root fan, middle fan, outer fan

Objectives To review and synthesize published evidence of pay-for-performance (P4P) effects on management of diabetes. Methods Databases including Ovid MEDLINE, EMbase, PubMed, The Cochrane Library (Issue 3, 2012) were comprehensively searched for the effects of P4P programs in terms of patient outcomes and physician behaviors. Studies covering detailed data were included and synthesized. The quality of the body of evidence for each quality indicator was determined using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Results Among 742 identified articles, 12 interrupted time series studies, 7 controlled before-after studies, and 2 cross-sectional studies were included. Additionally, 12 studies were further included for quantitative analysis. Results of meta-analysis showed that P4P produced generally positive effects in most indicators (eg, patients with records of total cholesterol or blood pressure). However, these results were inconsistent. The percentage of patients with HbA1c ≤ 7% or 53 mmol/mol showed a pooled odds ratio of 0.98 in patients, but a pooled mean difference of 19.71% in the physician groups. The odds ratios of receiving tests/reaching an outcome level were also diverse in patients (odds ratios ranged from 0.98 to 3.32). Besides, process indicators had higher rates of improvement than outcome indicators. Conclusions P4P programs have variable impacts on patient outcomes of diabetes as well as physician behaviors, with various effects from negligible to strongly beneficial. Considering the low quality of the included studies, this conclusion should be cautiously interpreted.

Supplemental Digital Content is available in the text, As the relationship between physicians and patients deteriorated in China recently, medical conflicts occurred more frequently now. Physicians, to a certain extent, also take some responsibilities. Awareness of medical professionalism and its influence factors can be helpful to take targeted measures and alleviate the contradiction. Through a combination of physicians’ self-assessment and patients’ assessment in ambulatory care clinics in Chengdu, this research aims to evaluate the importance of medical professionalism in hospitals and explore the influence factors, hoping to provide decision-making references to improve this grim situation. From February to March, 2013, a cross-sectional study was conducted in 2 tier 3 hospitals, 5 tier 2 hospitals, and 10 community hospitals through a stratified-random sampling method on physicians and patients, at a ratio of 1/5. Questionnaires are adopted from a pilot study. A total of 382 physicians and 1910 patients were matched and surveyed. Regarding the medical professionalism, the scores of the self-assessment for physicians were 85.18 ± 7.267 out of 100 and the scores of patient-assessment were 57.66 ± 7.043 out of 70. The influence factors of self-assessment were physicians’ working years (P = 0.003) and patients’ complaints (P = 0.006), whereas the influence factors of patient-assessment were patients’ ages (P = 0.001) and their physicians’ working years (P

The authors report on a 55-year-old man with complaints of intermittent pulsatile headache for 6 months, vision loss of the right eye and diplopia for 2 months. A magnetic resonance image (MRI) showed a large heterogeneously enhanced intrasellar mass lesion, occupying the entire hypophyseal fossa and extending into the sphenoid sinus. The patient underwent microscopic transsphenoidal surgery for removal of the tumor. Microscopic examination with hematoxylin&eosin and immunohistochemical staining of the tumor specimen was performed and confirmed the diagnosis of clear cell meningioma (CCM). Though postoperative MRI indicated gross total resection of the tumor, rapid recurrence was detected at 4 months after surgery. Gamma knife radiotherapy was administered. To the authors' knowledge, the present case is the first case of transsphenoidal removal of CCM. We reviewed the current literature on this rare histological type of meningioma in the sellar region.

A 19-year-old man presented with a rapidly growing right craniofacial lump and headache for 9 days, with vision loss in the right eye and no other manifestation of neurofibromatosis or neurologic disturbance. Imaging revealed a giant lesion with intratumoral hematoma and adjacent bone dysplasia (figure, A and B). The tumor and the involved right eye (figure, C) were removed following preoperative embolization. The wound was repaired using dorsal and lateral cervicothoracic flap grafting. Pathologic examination revealed a neurofibroma without malignant transformation.1 Solitary giant craniofacial neurofibromas with intratumoral hemorrhage are rare and require multidisciplinary care2 for optimal outcome (figure, D). Early intervention is preferable.

Background Cardiac masses are rare with high morbidity and mortality that challenging the management. The purpose of this study was to evaluate the potential role of cardiac-MRI based multi-modality imaging in the clinical decision-making for patients with cardiac mass. Methods From November 2011 to May 2014, 59 consecutive patients (33 females; mean age, 48.2±21.1 [range, 0.6–85] years) with suspected cardiac mass were enrolled in this prospective single center study, underwent MRI based multi-modality imaging and were followed up for survival status. Management strategy (surgery, chemotherapy or observation) was based on patient's clinical status and cardiac mass imaging characteristics (location, morphology, hemodynamics, embolization risk, metastasis, and resectability). Results Using cardiac MRI, 39 patients were diagnosed with intra-cardiac neoplasm (28 benign, 11 malignant) and 20 with pseudo-tumors (13 thrombi, 4 cysts and 3 fat infiltration); 34 masses (23 neoplasms, 11 pseudo-tumors) were eligible for surgical removal, and 4 underwent PET-CT scan to further delineate characteristics and metastasis. Pathological examination revealed high accuracy of cardiac MRI in differentiating benign from malignant tumors (96%), and neoplasm from pseudo-tumors (100%). As for the 16 patients with cardiac neoplasm not surgically treated, the 9 with "benign" masses as per MRI-based multimodality imaging survived during follow-up, while all 7 with "malignancy" died; the 9 with pseudo-tumors not surgically treated also survived with good condition. The median follow-up period is 2years (10days–3years). Conclusion Cardiac MRI based multimodality imaging appears useful for risk stratification and clinical decision making for patients with suspected cardiac mass.

Pay-for-performance is a financial incentive which links physicians' income to the quality of their services. Although pay-for-performance is suggested to be an effective payment method in many pilot countries (ie the UK) and enjoys a wide application in primary health care, researches on it are yet to reach an agreement. Thus, a systematic review was conducted on the evidence of impact of pay-for-performance on behavior of primary care physicians and patient outcomes aiming to provide a comprehensive and objective evaluation of pay-for-performance for decision-makers.Studies were identified by searching PubMed, EMbase, and The Cochrane Library. Electronic search was conducted in the fourth week of January 2013. As the included studies had significant clinical heterogeneity, a descriptive analysis was conducted. Quality Index was adopted for quality assessment of evidences.Database searches yielded 651 candidate articles, of which 44 studies fulfilled the inclusion criteria. An overall positive effect was found on the management of disease, which varied in accordance with the baseline medical quality and the practice size. Meanwhile, it could bring about new problems regarding the inequity, patients' dissatisfaction and increasing medical cost.Decision-makers should consider the baseline conditions of medical quality and the practice size before new medical policies are enacted. Furthermore, most studies are retrospective and observational with high level of heterogeneity though, the descriptive analysis is still of significance.

Rationale Aggressive pituitary adenomas and pituitary carcinomas are rare and demand multiple treatment strategies. Temozolomide, an orally active alkylating chemotherapeutic agent, has recently been recommended as a salvage medication for refractory pituitary adenomas or carcinomas. Patient concerns A 17-year-old male presenting with aggressive prolactinoma that continued to progress despite surgery, gamma knife, and dopamine agonists. Diagnoses The diagnosis of refractory aggressive prolactinoma was made on the basis of clinical findings and the lack of efficacy of conventional treatment. Interventions The patient received the most frequently recommended regimen of temozolomide treatment for 22 cycles. Outcomes Temozolomide resulted in a remarkable shrinkage of tumor mass and inhibition of prolactin secretion and this patient's clinical condition improved progressively. Lessons Temozolomide can be used as a salvage treatment to refractory pituitary tumors and o(6)-methylguanine-DNA methyltransferase (MGMT) status is a significant predictor to the effectiveness of temozolomide based on the existing literature.

Ventricular septal defect (VSD) is a common congenital heart disease. Open surgical repair with cardiopulmonary bypass (CPB) and sternotomy is the classic treatment. Percutaneous device closure is a minimally invasive alternative in treating selected VSDs, but it is limited by vascular access as well as radiation exposure especially in pediatric patients. Hybrid perventricular device closure of VSDs was designed to combine the advantages of both approaches allowing direct access to the defect without CPB and has gained wider acceptance in recent years. Under transesophageal echocardiography guidance, it could effectively close muscular, perimembranous, and even doubly committed defects. It is a safe and effective option for selected patients with congenital VSDs. In this article, we reviewed the application and results of this technique.

Pituitary carcinoma is extremely rare and difficult to diagnose early. Here we present a case of highly suspected pituitary malignant adenoma with early chemotherapy and radiation. A 30-year-old woman was admitted for headache and impaired vision, MRI found a sellar mass. Since there was no disturbance in serum hormone levels, she was diagnosed with non-functioning pituitary adenoma before surgery. Transsphenoidal removal of tumor was attempted but only partial resection of tumor was achieved. Pathology findings suggested a diagnosis of adenocarcinoma. PET-CT scan showed the tumor had elevated max standardized uptake value. No other abnormal sites were found, which excluded metastasis to pituitary. After surgery, the patient was treated with temozolomide assisted with radiation and tumor disappeared on MRI. No recurrence was observed on 1-year follow up. In conclusion, early temozolomide with radiation therapy for highly suspected pituitary carcinoma might be beneficial.

To review and synthesize published evidence of pay-for-performance (P4P) effects on management of diabetes.Databases including Ovid MEDLINE, EMbase, PubMed, The Cochrane Library (Issue 3, 2012) were comprehensively searched for the effects of P4P programs in terms of patient outcomes and physician behaviors. Studies covering detailed data were included and synthesized. The quality of the body of evidence for each quality indicator was determined using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system.Among 742 identified articles, 12 interrupted time series studies, 7 controlled before-after studies, and 2 cross-sectional studies were included. Additionally, 12 studies were further included for quantitative analysis. Results of meta-analysis showed that P4P produced generally positive effects in most indicators (eg, patients with records of total cholesterol or blood pressure). However, these results were inconsistent. The percentage of patients with HbA1c ≤ 7% or 53 mmol/mol showed a pooled odds ratio of 0.98 in patients, but a pooled mean difference of 19.71% in the physician groups. The odds ratios of receiving tests/reaching an outcome level were also diverse in patients (odds ratios ranged from 0.98 to 3.32). Besides, process indicators had higher rates of improvement than outcome indicators.P4P programs have variable impacts on patient outcomes of diabetes as well as physician behaviors, with various effects from negligible to strongly beneficial. Considering the low quality of the included studies, this conclusion should be cautiously interpreted.