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Paraganglioma (PGL) is an uncommon tumor located in the head, neck and abdomen. The majority of the tumor is benign and the patient has no obvious clinical symptoms. However, PGL located in the pancreas is rather rare and tends to mimic Castleman’s disease, pancreatic neuroendocrine tumors and pancreatic primary tumor. Herein, we reported a patient with PGL that occurred in the neck of the pancreas. A 75-year-old Chinese female presented to our hospital with a complaint of upper abdomen pain for two weeks and she had good past health. The laboratory findings and physical examination were all normal. Preoperative computed tomography (CT) and magnetic resonance imaging revealed a tumor located in the neck of the pancreas and a tentative diagnosis of Castleman’s disease or PGL was made. We resected the tumor by laparoscopic surgery. Postoperative pathology and immunohistochemistry confirmed that the tumor was a PGL. The patient was recovered well after a postoperative follow-up of 6 months. PGL located in the neck of the pancreas is difficult to be diagnosed accurately and clinicians have difficulties in distinguishing PGL from Castleman’s disease, pancreatic neuroendocrine tumors and pancreatic primary tumor. Fifteen cases were listed to show the characters of PGL located in the pancreas and we also presented the difference among PGL, Castleman’s disease and pancreatic neuroendocrine tumor. We showed our experience of treating such a rare tumor hoping to help clinicians correctly diagnose and treat PGL.

Renal tubules are vulnerable targets of various factors causing kidney injury in diabetic kidney disease (DKD), and the degree of tubular lesions is closely related to renal function. Abnormal renal tubular epithelial cells (RTECs) differentiation and depletion of cell junction proteins are important in DKD pathogenesis. Caudal-type homeobox transcription factor 2 (CDX2), represents a key nuclear transcription factor that maintains normal proliferation and differentiation of the intestinal epithelium. The present study aimed to evaluate the effects of CDX2 on RTECs differentiation and cell junction proteins in DKD. The results demonstrated that CDX2 was mainly localized in renal tubules, and downregulated in various DKD models. CDX2 upregulated E-cadherin and suppressed partial epithelial-mesenchymal transition (EMT), which can alleviate hyperglycemia-associated RTECs injury. Cystic fibrosis transmembrane conductance regulator (CFTR) was regulated by CDX2 in NRK-52E cells, and CFTR interfered with β-catenin activation by binding to Dvl2, which is an essential component of Wnt/β-catenin signaling. CFTR knockdown abolished the suppressive effects of CDX2 on Wnt/β-catenin signaling, thereby upregulating cell junction proteins and inhibiting partial EMT in RTECs. In summary, CDX2 can improve renal tubular lesions during DKD by increasing CFTR amounts to suppress the Wnt/β-catenin signaling pathway.

This study investigates the relationship of urban thermal environment (UTE) with various influential factors as well as ecological conditions. The relation between LST and land use and land cover (LULC) changes was explored in terms of remote-sensing (RS) based indices; heat effect contribution index (HECI), Urban thermal field variance index (UTFVI), Surface urban heat island intensity (SUHII), Normal Difference Built-up Index (NDBI), and Normal Difference Vegetation Index (NDVI). LULC maps were classified using the unsupervised classification technique and made error matrix to determine the accuracy. Results revealed that the vegetated area in Faisalabad decreased by 230 km2 due to an expansion in the urban area of 124-320 km2 during the period 1992-2014. An average LST in the rural buffers is increasing rapidly as compare to urban buffer and varied over the eight years with a range of 0.68-2.57 (°C). After 2007, SUHII's linear trend was negative because rural temperatures were still rising. Based on HECI, we found that urban expansion mainly led to increase in LST. UTFVI has shown poor ecological conditions in all urban buffers. In addition, there is a positive correlation between LST and NDBI, while NDVI indicates a negative correlation with LST.

The deteriorating environment has become an urgent global problem. As developing country, China is no exception. Demand for clean air is increasing in response to health and social problems. We use China's micro household survey data to explore individual residents' willingness to pay for environmental protection (WTP). Results show that air pollution improves WTP. A 100 ​μg/m³ increase in PM2.5 leads to approximately 84.1% WTP on a given day, but local residents are habituated to local pollution. We further study air pollution affects individual perceptions. We discuss the belief that local governments take pollution seriously can promote WTP. In addition, respondents who own smartphones, demonstrate environmental awareness, are happier, and enjoy higher household assets and income are willing to pay more.

Aim Arteriovenous malformation (AVM) embolisation is in peril after the ARUBA trial. Advancements that are needed to reduce procedural risk are better control and visualisation during micro-catheter injection of liquid embolic material. The injectability, radiographic visualisation, mechanical stability and biocompatibility of the embolic agent Fe3O4-EVOH was evaluated in an in vivo swine AVM model. Methods The swine AVM model is the rete mirabile (RM). Nine swine AVM models were embolised with the embolic agent Fe3O4-EVOH by using a 1.5 F micro-catheter. Procedure times, embolisation success (defined as complete embolisation of the nidus), volume of embolic agent and histopathology were assessed. Results Six swine underwent embolisation of one side rete, and three underwent embolisation of both sides. We did not experience any technical complication during embolisation of each rete. The micro-catheter was easy to retrieve. Fluoroscopic visualisation of the Fe3O4-EVOH cast was adequate. The mean embolisation time for each RM was 7.5 minutes. The median volume of the embolic agent for each RM was 0.52 mL. At one, four and eight weeks following injection, microscopic and histological analysis demonstrated minimal inflammatory changes in the perivascular tissues and permanent occlusion of the embolised vasculature. Conclusion Fe3O4-EVOH embolic agent is an effective endovascular occlusion material, providing the initial in vivo characteristics of stability and biocompatibility.

Based on three-dimensional seismic interpretation, structural and sedimentary feature analysis, and examination of fluid properties and production dynamics, the regularity and main controlling factors of hydrocarbon accumulation in the Tazhong uplift, Tarim Basin are investigated. The results show that the oil and gas in the Tazhong uplift has the characteristics of complex accumulation mainly controlled by faults, and more than 80% of the oil and gas reserves are enriched along fault zones. There are large thrust and strike-slip faults in the Tazhong uplift, and the coupling relationship between the formation and evolution of the faults and accumulation determine the difference in complex oil and gas accumulations. The active scale and stage of faults determine the fullness of the traps and the balance of the phase, that is, the blocking of the transport system, the insufficient filling of oil and gas, and the unsteady state of fluid accumulation are dependent on the faults. The multi-period tectonic sedimentary evolution controls the differences of trap conditions in the fault zones, and the multi-phase hydrocarbon migration and accumulation causes the differences of fluid distribution in the fault zones. The theory of differential oil and gas accumulation controlled by fault is the key to the overall evaluation, three-dimensional development and discovery of new reserves in the Tazhong uplift. Key words: Tarim Basin, Tazhong uplift, fault zone, complex oil and gas accumulation, oil and gas distribution, difference, main controlling factor

Objective Acute hemorrhagic cerebral artery dissection may show a subtle stenosis and bulge on an angiogram, for which diagnosis and treatment are difficult. This report describes seven cases of acute hemorrhagic cerebral artery dissection treated by endovascular techniques. Patients and methods From January 2018 to April 2019, seven patients (22–76 years old) were diagnosed with subarachnoid hemorrhage caused by cerebral artery dissection. Six patients were treated by low-profile visualized intraluminal support stent-assisted coiling and there was a sacrifice of the posterior cerebral artery in one patient. Cerebral angiography results were obtained immediately after intervention and at follow-up. Clinical outcome was evaluated by a modified Rankin Scale score. Results Four dissections were angiographic changes of subtle stenosis and small bulges; three were apparent angiographic changes of stenosis or fusiform morphologies. All seven aneurysms were completely obliterated, a low-profile visualized intraluminal support stent was used in six patients and coil occlusion of the parent artery in one patient. Complications occurred in two cases of proximal posterior cerebral artery dissection. One bleeding complication was observed intra-procedure and one ischemic complication was observed after stent-assisted coiling. The angiographic and clinical follow-up was obtained at 3–8 months in five patients. Good recovery was achieved for six patients (modified Rankin Score 0); one patient who presented Weber syndrome caused by ischemic complication had a modified Rankin Score of two at 8 months follow-up. Conclusion Hemorrhagic cerebral artery dissection may show subtle stenosis, small bulges or fusiform morphologies on angiograms. Treatment of proximal posterior cerebral artery dissection is challenging. Endovascular reconstruction with a low-profile visualized intraluminal support stent was effective depending on the angiographic morphology.

Background Spinal angiolipomas (SALs) are benign tumors that usually present a slow progressive spinal cord or radicular compression. Acute myelopathy or acute aggravated radicular syndrome are exceedingly rare. Case Description The authors report an original case with sudden aggravated radicular pain caused by hemorrhagic SALs. A 54-year-old woman presented with a 2-month history of mild back pain, and the pain was significantly aggravated after a therapeutic back massage. Neurologic examination showed pain and hyperalgesia between T4 and T7 dermatome, from back to front, just like a band. Spinal magnetic resonance imaging (MRI) showed a dorsally located epidural lesion (T4–T6) and a small intratumoral hemorrhage at the lower part of the tumor. A bilateral T4–T6 laminectomy was performed to achieve total excision of the tumors. Histologic examination showed that the tumors were composed of mature adipose tissue and vascular tissue as angiolipomas. The postoperative course was uneventful with complete neurologic recovery 4 days after the surgery. MRI at 1-year follow-up indicated no recurrence. Conclusions SALs are unusual benign tumors that are composed of mature fatty tissue and abnormal blood vessels; sudden aggravated spinal cord or radicular compression syndrome is rare. MRI is the best choice in the diagnosis of SALs. Surgery may be performed in different ways depending on the type of SALs, and the prognosis is generally good.

Seeking the unprecedented ability of metasurfaces to manipulate terahertz waves in a desired manner has attracted increasing interest. We design and investigate a kind of multi-channel, polarization-dependent transmission-type dielectric metasurface-based terahertz beam splitter. It is numerically demonstrated that such metasurfaces can manipulate terahertz beam, and split it into four channels with alterable angles and orthogonal polarizations, under the linearly polarized incidence with both the x - and y –polarization components. The suggested regime may alleviate the shortage of advanced multifunctional devices and provide extra freedom for terahertz functional device design.

The achievable functionalities of metasurfaces are mainly determined by the capability of their unit cells to control the local electromagnetic responses. To realize full control over light, it is highly desired to find a kind of unit cell that can achieve complete control of the phase, amplitude, and polarization, which remains a big challenge and cannot be fully replaced with iteration algorithms. Here, such control is achieved by exploiting interference in a dielectric unit cell composed of multiple meta-atoms, namely, a meta-molecule. This strategy provides sufficient effective geometric degrees of freedom within the meta-molecule to enable full control over its optical properties, as is demonstrated here with a complete meta-molecule database. As a proof-of-concept demonstration, polarization-independent, polarization-dependent, and vectorial meta-holograms are proposed and experimentally characterized. High imaging quality is achieved in both the measured intensity and phase distributions. This is allowed by the ability of the meta-molecules to fully record the information of the target images. This strategy opens a direct way toward optical devices with various desirable functionalities.

To compare the plasma lipid profiles in women with normal pregnancies and those with mild or severe intrahepatic cholestasis of pregnancy (ICP). Our goal was to reveal lipidome-wide alterations in ICP and delve into the pathogenesis of ICP from a lipid metabolism perspective.Cross-sectional study, including women with normal pregnancies, women with mild ICP and women with severe ICP.Gansu Provincial Hospital.Women with ICP were recruited from October 2019 to March 2020 in Gansu, China.Untargeted lipidomics was used to analyse differentially expressed plasma lipids in controls, in women with mild ICP and in women with severe ICP (n = 30 per group). For lipidomics, liquid chromatography and Q-Exactive Plus Orbitrap mass spectrometry were performed.Differentially expressed lipids.Thirty-three lipids were differentially expressed in the severe and mild ICP groups, compared with the control group, and 20 of those were sphingolipids (ceramide, six species; sphingomyelin, 14 species). All differentially expressed sphingolipids in women with mild ICP were also differentially expressed in women with severe ICP; the fold change and significance of the differential expression were positively correlated with disease severity.We systematically characterized the lipidome-wide alterations in mild and severe ICP groups. The results indicated a link between ICP and disordered sphingolipid homeostasis.Abnormal sphingolipid metabolism is involved in the pathogenesis of ICP.

We present our experience in using the single Solitaire AB stent for small wide-neck bifurcation aneurysms (WNBAs).During 18 months, 20 small (the largest width10 mm) WNBAs were treated with the single Solitaire AB stent-assisted coiling. The patients were 12 women and 8 men, with a mean age of 52 years (range: 36-66 years). The mean aneurysm size was 4.2 mm (2-9 mm) and mean neck size was 3.9 mm (2-9 mm). Results at follow-up were graded as complete occlusion, neck remnant, or residual aneurysm.All 20 small WNBAs were adequately occluded after a single Solitaire AB stent placement. There were no procedural ruptures and no thromboembolic complications occurred. Two patients developed a transient neurological deficit. In 20 patients with angiographic follow-up at 6 months, 16 (80%) aneurysms remained adequately occluded. Clinical follow-up in the 20 patients revealed mRS 0-2 in all.Single Solitaire AB stent-assisted coil embolization for small WNBAs was safe and effective.

Integrating multiple functionalities into a single device is a striking field in metasurfaces. Here, we experimentally demonstrate several efficiently multifunctional dielectric metasurfaces in the terahertz regime using a spin-decoupled phase control method allowed by simultaneous control of dynamic phase and geometric phase. The designing strategy shows an impressive robustness and a great flexibility in designing metasurface-based multifunctional devices, and opens new avenues toward the applications in beam steering and polarization multiplexing.

Background: To assess the effect of methylprednisolone on the prognosis of patients with novel coronavirus pneumonia.Methods: Patients with confirmed novel coronavirus pneumonia discharged from Wuhan Third Hospital Guanggu Campus, Shouyi Campus, and Lei Shen Shan Hospital from January 31, 2020, to March 4, 2020, were included. The patients were divided into treatment and control groups according to whether methylprednisolone was used during hospitalization. Propensity score (PS) matching analysis was used to assess in-hospital mortality as the primary outcome and trends in the changes in lymphocytes and the C-reactive protein, creatinine and transaminase levels 7 days after admission (secondary outcomes).Results: A total of 2,062 patients with confirmed novel coronavirus pneumonia were included in this study. Univariate Cox regression analysis suggested that methylprednisolone treatment was associated with increased in-hospital mortality (hazard ratio (HR) 3.70, 95% confidence interval (CI) 2.62-5.23, P9/L. Kaplan-Meier survival curve analysis showed that methylprednisolone treatment reduced the risk of in-hospital death in patients with lymphocyte counts less than 0.9×109/L (P=0.022). In contrast, in the normal lymphocyte group, methylprednisolone treatment was not associated with in-hospital mortality (p=0.88).Conclusion: Treatment with methylprednisolone may be associated with reduced in-hospital mortality in coronavirus disease (COVID) patients with low lymphocyte counts.

Background: The patients on mechanical ventilation were always critically ill and ventilation may cause injury and inflammatory disorders in the lungs of such patients. We sought to determine whether statin treatment has a protective effect on the outcome of the ventilated patients. Methods: A retrospective observational study of mechanically ventilated patients from the Medical Information Mart for Intensive Care III (MIMIC-III) database. To ensure the robustness of the findings, we utilized the gradient boosted model, propensity score analysis, doubly robust estimation and an inverse probability‐weighting model in the statistical procedure. The propensity score of statin use was calculated by age, sex, severity scores and 32 other variables. Results: Compared with nonusers, the use of statins was associated with improved 28-day survival in the unmatched cohort (HR 0.85 95% CI 0.80~0.90) and matched cohort (HR 0.79 95% CI 0.73~0.85). Statin use was also associated with improved 60-day (HR 0.81 95%CI 0.75~0.85), 90-day (HR 0.81 95%CI 0.76~0.86) and in-hospital (HR 0.81 95%CI 0.76~0.86) survival in the matched cohort. Statins use was associated with longer ventilator free days (VFD28, 14.93±13.11 vs 12.06±13.26) and longer ICU free days (13.41±12.14 vs 10.86 ±12.19) in the matched cohort. Different types of statins were associated with improved 28-day survival. The subgroup analyses results showed improved 28-day survival in most subgroups, but this improvement was not observed in patients with pneumonia, septicemia or acute respiratory failure. Conclusions: In a population of mechanically ventilated patients, the use of statins may be associated with reduced mortality. This protective effect was observed only in mild-to-moderate patients instead of critical inflammatory ones.Trial registration: http://www.chictr.org.cn/index.aspx; Registration number: ChiCTR2000029594

Core-shell heterostructure nanomaterials are promising candidate for supercapacitor electrodes owing to their effective electrolyte accessibility and rapid electrons transport rates. In this work, multi-dimensional core-shell NiCo2O4@NiMoO4 nanowires/nanosheets arrays are successfully grown on carbon cloth via a two-step hydrothermal route coupled with post annealing process. The thickness of NiMoO4 shell can be easily controlled by using a alkali sources or not in the secondary hydrothermal process and the dependence of electrochemical performance on the NiMoO4 shell thickness is researched. Owing to a higher specific surface area, lower electrons transfer resistance and good strain accommodation, the heterostructure electrode with a thick NiMoO4 shell exhibits the optimal electrochemical performance, showing a high areal capacitance of 2522 mF cm−2 and superior cycle performance of 89.8% capacitance retention over 5000 cycles. Moreover, using it as positive electrode and activated carbon as negative electrode, the fabricated asymmetric supercapacitor delivers a maximum energy density of 53.3 Wh kg−1 at 750 W kg−1, indicating its promising applications as efficient electrode for supercapacitors.

OBJECTIVELaminoplasty has been used in recent years as an alternative approach to laminectomy for preventing spinal deformity after resection of intramedullary spinal cord tumors (IMSCTs). However, controversies exist with regard to its real role in maintaining postoperative spinal alignment. The purpose of this study was to examine the incidence of progressive spinal deformity in patients who underwent laminoplasty for resection of IMSCT and identify risk factors for progressive spinal deformity.METHODSData from IMSCT patients who had undergone laminoplasty at Beijing Tsinghua Changgung Hospital between January 2014 and December 2016 were retrospectively reviewed. Univariate tests and multivariate logistic regression analysis were used to assess the statistical relationship between postoperative spinal deformity and radiographic, clinical, and surgical variables.RESULTSOne hundred five patients (mean age 37.0 ± 14.5 years) met the criteria for inclusion in the study. Gross-total resection (> 95%) was obtained in 79 cases (75.2%). Twenty-seven (25.7%) of the 105 patients were found to have spinal deformity preoperatively, and 10 (9.5%) new cases of postoperative progressive deformity were detected. The mean duration of follow-up was 27.6 months (SD 14.5 months, median 26.3 months, range 6.2–40.7 months). At last follow-up, the median functional scores of the patients who did develop progressive spinal deformity were worse than those of the patients who did not (modified McCormick Scale: 3 vs 2, and p = 0.04). In the univariate analysis, age (p = 0.01), preoperative spinal deformity (p < 0.01), extent of tumor involvement (p < 0.01), extent of abnormal tumor signal (p = 0.02), and extent of laminoplasty (p < 0.01) were identified as factors associated with postoperative progressive spinal deformity. However, in subsequent multivariate logistic regression analysis, only age ≤ 25 years and preoperative spinal deformity emerged as independent risk factors (p < 0.05), increasing the odds of postoperative progressive deformity by 4.1- and 12.4-fold, respectively (p < 0.05).CONCLUSIONSProgressive spinal deformity was identified in 25.7% patients who had undergone laminoplasty for IMSCT resection and was related to decreased functional status. Younger age (≤ 25 years) and preoperative spinal deformity increased the risk of postoperative progressive spinal deformity. The risk of postoperative deformity warrants serious reconsideration of providing concurrent fusion during IMSCT resection or close follow-up after laminoplasty.

Background The SNP rs3747333 and rs3747334 in Neuroligin 4X (NLGN4X) gene have been demonstrated to be associated with the susceptibility to Autism spectrum disorder (ASDs; MIM 209850), but the results are inconsistent. Therefore, a meta-analysis of eligible studies reporting the association between rs3747333 and rs3747334 and ASD was carried out to enhance the reliability of published results. Methods A systematic literature search was performed using PubMed, Web of Science, Cochrane Library to search English articles concerning the relation between rs3747333, rs3747334 and ASD up to Sep. 21th, 2017. Summary odds ratios (OR) and 95% confidence interval (CI) were used to evaluate the risk of rs3747333, rs3747334 in the ASD. The heterogeneity and publication bias of the eligible studies were also evaluated. Results Six eligible studies involving 1284 subjects (735 patients and 549 healthy controls) were included in this meta-analysis. Overall, the results indicated that there was no significant risk elevation between rs3747333, rs3747334 variants and ASD (OR = 0.39, 95% CI 0.10–1.60). Furthermore, sensitivity analysis and publication bias analysis confirmed this result. Conclusions In conclusion, our meta-analysis suggests that the rs3747333, rs3747334 in NLGN4X gene are not frequent causes of ASD. Electronic supplementary material The online version of this article (10.1186/s12991-019-0227-5) contains supplementary material, which is available to authorized users.

The transmission characters of a narrow slit were an interesting topic for a long time. In this paper, the transmission characters of an air slit carved form a metal film was discussed rigorously. The narrow slit was treated to be a three-layer-waveguide with two complex refractive index claddings. The transmission character eigen equations were derived by solving analytically from Maxwells equations and by matching the boundary conditions at the interfaces. The electromagnetic fields in both sides of the claddings and inside of the air slit were obtained. For a given example, numerical simulations were presented. The field distribution and the longitude phase constants at different wavelengths and with different width of the slits were calculated. Five modes were supported, and one surface Plasmon mode was attributed and four guided modes were attributed from their transmission characters. The p-polarized surface Plasmon mode might play an important role in the extraordinary optical transmission of light through arrayed subwavelength holes.

Hypertension crisis is a severe disease and needs emergency treatment in clinic. It is an important task to discover novel drugs which could lower the blood pressure steadily and quickly. However, animal models for screening anti-hypertensive crisis agents are unsatisfactory. The present study aimed to establish a new hypertensive crisis rat model and then explore the therapeutic effects of three Rho-kinase inhibitors including Fasudil, DL0805-1 and DL0805-2 on such a disease model. The hypertensive crisis symptoms were developed on male Wistar rats by subcutaneously injecting small doses of norepinephrine (NE) for 10 days in the initial stage. A sudden increase in blood pressure (BP) was then induced by excessive NE infusion. Compounds to be tested were intravenously injected into the rats immediately when the rapidly increased systolic blood pressure appeared. The results have shown that after small dose administration with NE, the rats could obtain acute BP increase to a high level without sudden death when a large dose of NE was injected. Fasudil, DL0805-1 and DL0805-2 could lower the blood pressure quickly in a dose dependent manner and improve the survival rate. The compounds also prevent the animals from organ damage. In conclusion, we established a novel hypertensive crisis animal model which could evaluate agents within a short time. In this model, we found that three Rho-kinase inhibitors have potential therapeutic effects on hypertensive crisis. This work might contribute to the discovery and development of new anti-hypertensive crisis drugs.

Introduction: Guillain-Barré syndrome (GBS) is a common autoimmune disease in the peripheral nervous system. This study aimed to elucidate the role of IL-27 gene polymorphisms in elderly people with GBS. Methods: A total of 395 healthy subjects and 422 GBS patients with an average age of 63 years old were included in this study. Peripheral blood samples were collected. The 2 single-nucleotide polymorphisms (SNPs) of IL-27, namely, rs153109 and rs785575, of GBS patients were analyzed using the PCR method and compared with those of the healthy controls. The correlations of IL-27 SNPs with disease severity, disease outcome, level of anti-GM1 antibodies, and Campylobacter jejuni infection were assessed. Serum levels of IL-27 of healthy subjects and GBS patients were analyzed using enzyme-linked immunosorbent assay. Results: No significant differences in the frequencies of rs785575 SNPs between GBS and healthy subjects were observed. In analyzing rs153109 SNPs, the G allele was found to be more prevalent in the GBS patients (p = 0.012). More alleles show GG genotype in GBS patients (p = 0.023). The −964A>G allele has a higher prevalence in severely affected and anti-GM1-Ab-positive GBS patients. GBS patients with the rs153109 SNP showed a poor clinical outcome than those without rs153109 SNP (p = 0.012). GBS patients showed higher serum IL-27 levels than healthy subjects (p < 0.001). The levels of IL-27 were also higher in GBS patients with genotypes of AG and GG, and those with GG genotypes showed the highest IL-27 levels. Conclusion: The rs153109 SNP is more prevalent in GBS patients with the GG and G allele and is associated with severer GBS, poorer clinical outcomes, and higher IL-27 levels.

Large-artery atherosclerotic (LAA) stroke is the most common subtype of ischemic stroke. However, risk factors for long-term outcomes of LAA stroke in the elderly Chinese population have not been well-described. Therefore, we aimed to assess outcomes and risk factors at 3, 12, and 36 months after LAA stroke onset among stroke patients aged 60 years and older. All consecutive LAA patients aged ≥ 60 years were prospectively recruited from Dongying People's Hospital between January 2016 and December 2018. The clinical features and outcome data at 3, 12, and 36 months after stroke were collected. Differences in outcomes and relationship between outcomes and risk factors were assessed. A total of 1,772 patients were included in our study (61.7% male, 38.3% female). The rates of mortality, recurrence, and dependency were 6.6, 12.6, and 12.6%, respectively, at 3 months after stroke onset. The corresponding rate rose rapidly at 36 months (23.2, 78.7, and 79.7%, respectively). We found the positive predictors associated outcomes at 3, 12, and 36 months after stroke onset. The relative risk (RR) with 95% confidential interval (CI) is 1.06 (1.02–1.10, P = 0.006) at 3 months, 1.06 (1.02–1.10, P = 0.003) at12 months, and 1.10 (1.05–1.15, P < 0.001) at 36 months after stroke onset for age; 1.09 (1.01–1.19, P = 0.029) at 12 months for fasting plasma glucose (FPG) level; 4.25 (2.14–8.43, P < 0.001) at 3 months, 4.95 (2.70–9.10, P < 0.001) at 12 months, and 4.82 (2.25–10.32, P < 0.001) at 36 months for moderate stroke; 7.56 (3.42–16.72, P < 0.001) at 3 months, 11.08 (5.26–23.34, P < 0.001) at 12 months, and 14.30 (4.85–42.11, P < 0.001) at 36 months for severe stroke, compared to mild stroke. Hypersensitive C-reactive protein (hs-CRP) level was an independent risk factor for mortality at different follow-up times, with the RR (95%) of 1.02 (1.01–1.02, P < 0.001) at 3 months, 1.01 (1.00–1.02, P = 0.002) at 12 months. White blood cell count (WBC) level was associated with both stroke recurrence (RR = 1.09, 95%CI: 1.01–1.18, P = 0.023) and dependency (RR = 1.10, 95%CI: 1.02–1.19, P = 0.018) at 3 months. In contrast, a higher level of low-density lipoprotein cholesterol (LDL-C) within the normal range was a protective factor for recurrence and dependency at shorter follow-up times, with the RR (95%) of 0.67 (0.51–0.89, P = 0.005) and 0.67 (0.50–0.88, P = 0.005), respectively. These findings suggest that it is necessary to control the risk factors of LAA to reduce the burden of LAA stroke. Especially, this study provides a new challenge to explore the possibility of lowering LDL-C level for improved stroke prognosis.

BackgroundThe patients on mechanical ventilation were always critically ill and ventilation may cause injury and inflammatory disorders in the lungs of such patients. We sought to determine whether statin treatment has a protective effect on the outcome of the ventilated patients. MethodsA retrospective observational study of mechanically ventilated patients from the Medical Information Mart for Intensive Care III (MIMIC-III) database. To ensure the robustness of the findings, we utilized the gradient boosted model, propensity score analysis, doubly robust estimation and an inverse probability‐weighting model in the statistical procedure. The propensity score of statin use was calculated by age, sex, severity scores and 32 other variables. ResultsCompared with nonusers, the use of statins was associated with improved 28-day survival in the unmatched cohort (HR 0.85 95% CI 0.80~0.90, p

Miniaturized ultrafast switchable optical components with an extremely compact size and a high-speed response will be the core of next-generation all-optical devices instead of traditional integrated circuits, which are approaching the bottleneck of Moore’s Law. Metasurfaces have emerged as fascinating subwavelength flat optical components and devices for light focusing and holography applications. However, these devices exhibit a severe limitation due to their natural passive response. Here we introduce an active hybrid metasurface integrated with patterned semiconductor inclusions for all-optical active control of terahertz waves. Ultrafast modulation of polarization states and the beam splitting ratio are experimentally demonstrated on a time scale of 667 ps. This scheme of hybrid metasurfaces could also be extended to the design of various free-space all-optical active devices, such as varifocal planar lenses, switchable vector beam generators, and components for holography in ultrafast imaging, display, and high-fidelity terahertz wireless communication systems., Active metasurfaces: Terahertz control All-optical control and manipulation of terahertz waves is now possible thanks to the development of custom-designed, dynamic reconfigurable metasurfaces. Realized by Longqing Cong and coworkers from Nanyang Technological University in Singapore and Tianjin University in China, the metasurfaces enable ultrafast (sub-nanosecond) polarization switching and beam splitting. They consist of an array of miniature aluminum-coated silicon split-ring resonators on a sapphire substrate. Illumination with short pulses of an infrared “pump beam” causes charge carriers in the silicon patch of the microring to transition from the valence to the conduction band, temporarily changing the photoconductivity and thus switching the transmission of the metasurface between “off” and “on” states for a polarized terahertz wave. Such high-speed switching of polarization is expected to be useful for applications such as data-encoding and multiplexing in a terahertz communications system as well as holography.

Neutrophil gelatinase-associated lipocalin (NGAL), also called lipocalin 2, is considered a promising biomarker for acute and chronic kidney injuries. Several studies have demonstrated that its levels increase in plasma and urine in diabetic nephropathy (DN), and its urine concentration increases upon kidney function deterioration. However, its role in DN progression remains unclear. The current study used in vitro gene expression knockdown in human proximal tubular cell line human kidney (HK)2 to investigate the role of NGAL in oxidation and extracellular matrix secretion under high-glucose (HG) incubation. In addition, type 1 diabetes was induced in vivo in knockout NGAL-/- and wild-type mice in order to investigate role of NGAL in the progression of DN. The results demonstrated that NGAL knockdown in HK2 cells significantly increased oxidative stress under HG stimulation tested by flow cytometry, and increased the secretion of interleukin-6, fibronectin (FN) and collagen IV examined by ELISA. Western blotting demonstrated that the phosphorylation of Smad2/3 also increased in HK2 cells under transforming growth factor-β1 stimulation. In vivo experiments demonstrated that diabetic NGAL-/- mice showed deteriorated renal function compared with that of diabetic wild-type mice. Histopathological analysis suggests that diabetic NGAL-/- mice had more serious glomerulosclerosis and tubular vascular degeneration than wild-type mice. Immunohistochemistry suggested that the absence of NGAL lead to increased FN deposition in glomeruli in a mouse model of DN. In conclusion, NGAL appears to have renal protective effects by slowing down the progression of DN, and its effect may be associated with a reduction in oxidation, fibrosis and inflammation.

As COVID-19 rampages throughout the world and has a major impact on the healthcare system, non-emergency medical procedures have nearly come to a halt due to appropriate resource reallocation. However, pain never stops, particularly for patients with chronic intractable pain and implanted spinal cord stimulation (SCS) devices. The isolation required to fight this pandemic makes it impossible for such patients to adjust the parameters or configuration of the device on site. Although telemedicine has shown a great effect in many healthcare scenarios, there have been fewer applications of such technology focusing on the interaction with implanted devices. Here, we introduce the first remote and wireless programming system that enables healthcare providers to perform video-based real-time programming and palliative medicine for pain patients with a SCS implant. During the COVID-19 pandemic from January 23, 2020, the date of lockdown of Wuhan, to April 30, 2020, 34 sessions of remote programming were conducted with 16 patients. Thirteen of the 16 patients required programming for parameter optimization. Improvement was achieved with programming adjustment in 12 of 13 (92.3%) cases. Eleven of the 16 (68.8%) patients reported that the system was user-friendly and met their needs. Five patients complained of an unstable connection resulting from the low network speed initially, and three of these patients solved this problem. In summary, we demonstrated that a remote wireless programming system can deliver safe and effective programming operations of implantable SCS device, thereby providing palliative care of value to the most vulnerable chronic pain patients during a pandemic.Clinical Trial Registrationwww.clinicaltrials.gov, identifier NCT 03858790.

BackgroundGlomerular disease patients have a high risk of infection, which contributes to the progression of disease per se and mortality, especially in those with long-term use of glucocorticoids and (or) immunosuppressive agents. Cases of sporadic nocardiosis have been reported in glomerular disease patients, and this observation was conducted to comprehensively understand the manifestations of and treatments for nocardiosis, which is commonly misdiagnosed as pneumonia or tuberculosis or even as lung cancer or metastatic tumors in glomerular disease patients.MethodsWe reviewed the demographic characteristics, laboratory abnormalities, radiological features, and treatments of 7 patients with nocardiosis and glomerular disease receiving steroids and immunosuppression therapy at the nephrology department of the Second Xiangya Hospital between 2012 and 2019.ResultsIt was found that all 7 patients had been receiving methylprednisolone for renal disease at a median dose of 20 mg per day and a median duration of 4 months before developing nocardiosis. There were 4 males and 3 females, and the median age was 52.14 years. All 7 patients had hypoalbuminemia at the time of admission. In addition, various cystic abscesses in the subcutaneous tissue, with or without lung and brain involvement, were observed in these patients. Encouragingly, body temperatures returned to normal, and subcutaneous abscesses diminished or disappeared with compound sulfamethoxazole treatment alone or in combination with linezolid, imipenem and mezlocillin/sulbactam.ConclusionsIt was shown that multisite abscesses, including subcutaneous, pulmonary and cerebral abscesses, were the common manifestations of nocardiosis in glomerular disease patients. Sulfonamide was the first-line antibiotic therapy for nocardiosis, and combinations of other antibiotics were also needed in some serious cases.

Background: Snoring is a common condition. Previous studies have reported the relationships between snoring and metabolic syndrome (MetS) and/or its five components: hypertension, hyperglycemia, low-high density lipoprotein (low-HDL), high-triglyceride level, and abdominal obesity. However, conclusions have been inconsistent, and there has been no comprehensive summary on this. Therefore, we performed a systematic review on the relationships between snoring and MetS, including each of MetS' components. Methods: A systematic review and a meta-analysis were conducted following the Meta-analysis of Observational Studies in Epidemiology group and Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Electronic databases including PubMed, Embase, and the Cochrane Library were searched for publications from inception to 15 July 2020. The inverse-variance weighted method was used in the meta-analysis to calculate the pooled odds ratios (ORs) and their 95% confidence intervals (CIs) to determine the association between snoring and MetS (and its components) through a fixed or random effect model. A restricted cubic spline regression model and the linear regression model were used in a two-stage dose-response meta-analysis to evaluate the non-linear and the linear trends between snoring frequency and MetS and its components. Results: A total of 40 studies with 966,652 participants were included in this study. The pooled ORs between snoring and MetS and its components, hypertension, hyperglycemia, low-HDL, high-triglyceride level, and abdominal obesity, were 1.61 (95% CI, 1.43-1.78), 1.23 (95% CI, 1.15-1.31), 1.05 (95% CI, 1.04-1.07), 1.09 (95% CI, 1.00-1.18), 1.08 (95% CI, 1.00-1.17), and 1.75 (95% CI, 1.46-2.05), respectively. Non-linear trends were detected in the five associations except for low-HDL. A linear trend was detected in the association of snoring with hypertension, hyperglycemia, low-HDL, or abdominal obesity, with ORs of 1.07 (95% CI, 1.01-1.13), 1.05 (95% CI, 1.02-1.08), 1.03 (95% CI, 1.02-1.04), and 1.17 (95% CI, 1.16-2.89), respectively. Conclusion: Snoring was a risk factor of MetS, and a dose-response relationship existed between the two. Timely intervention in identifying snorers can minimize as much as possible the risk of metabolic syndrome in those who snore.

Background Cellulosimicrobium cellulans is a gram-positive filamentous bacterium found primarily in soil and sewage that rarely causes human infection, especially in previously healthy adults, but when it does, it often indicates a poor prognosis. Case presentation We report a case of endocarditis and intracranial infection caused by C. cellulans in a 52-year-old woman with normal immune function and no implants in vivo. The patient started with a febrile headache that progressed to impaired consciousness after 20 days, and she finally died after treatment with vancomycin combined with rifampicin. C. cellulans was isolated from her blood cultures for 3 consecutive days after her admission; however, there was only evidence of C. cellulans sequences for two samples in the second-generation sequencing data generated from her peripheral blood, which were ignored by the technicians. No C. cellulans bands were detected in her cerebrospinal fluid by second-generation sequencing. Conclusions Second-generation sequencing seems to have limitations for certain specific strains of bacteria.

Background Gene expression profiling (GEP) is considered as gold standard for cell-of-origin classification of diffuse large B-cell lymphoma (DLBCL). The high dimensionality of GEP limits its application in clinical practice. Penalized regression was commonly used to determine the optimal gene subset for classification in high dimensional gene data. However, the results of penalized regression methods were affected by the tuning parameters.Results To solve the instability of penalized regression methods, we proposed a strategy to measure the importance of variables with an aggregated index. This strategy was applied to six penalized methods to identify a small gene subset for DLBCL classification. Using a training dataset of 350 DLBCL patients, we identified six genes (MYBL1, TNFRSF13B, MAML3, CYB5R2, BATF, and S1PR2) as the optimal gene subset for DLBCL classification. The AUC was 0.9986 (95%CI 0.9967–1) and discrimination slope (DS) was 0.9442 (95%CI 0.9203–0.9661) in the training dataset. The discriminative performances were further validated in the external dataset with an AUC of 0.9455 (95%CI 0.9298–0.9612) and DS of 0.6211 (95%CI 0.5824–0.6591). Additionally, the calibration and clinical usefulness were apt in both datasets. Subgroups of patients characterized by these six genes showed significantly different prognosis. Furthermore, model comparisons demonstrated that the six-gene model outperformed models constructed by typical penalized regression methods.Conclusions The six genes had considerable clinical usefulness in DLBCL classification and prognosis. Penalized variable importance analysis is an efficient strategy to identify an optimal gene subset with good predictive performance.

Neonatal sepsis (NS) has no specific clinical manifestations and blood culture analysis requires a long period of time. Knowledge of prevalent bacterial isolates and their antibiotic susceptibility is crucial when choosing an empirical therapy to decrease morbidity and mortality. This literature review summarizes the distribution characteristics and antimicrobial resistance of bacterial pathogens associated with bloodstream infections in Chinese neonates, and thus serves as a reference for pediatricians.The full-text journal database, CNKI, was searched using the key words "neonatal", "sepsis", and "bacterial pathogen" to retrieve relevant literature published from 2016 up to April 2018. The following data were extracted from the selected papers: title, pathogen collection time, care unit name, province (city), distribution of bacterial pathogens among bloodstream infections, and antimicrobial resistance of major pathogens.A total of 86 articles were searched, of which 30 complied with the study requirements and thus were included in the review; all were retrospective studies. The articles covered a total of 4098 bacterial strains from 24 cities (2494 Gram-positive bacteria, 1429 Gram-negative bacteria, 176 fungi). Among the Gram-positive bacteria, the four pathogens with the highest detection rates were coagulase-negativeMedical care-related infections in neonatal intensive care units (NICUs) were more often caused by CoNS than by

Social networks are a complex system that members communicate, create new connections or destroy existing connections, and further deliver major impacts on each member’s life. Given the spread of the Internet and increased academic pressure, sedentary and prescreen behaviors are very common among adolescents; meanwhile, sports behaviors are gradually decreasing. This situation has had an adverse effect on health. This paper used a questionnaire survey to investigate the influence of social networks on adolescent sports behavior, including the intermediary role of social efficacy and moderating effect of self-presentation. The questionnaire survey was conducted on 568 students from 6 high schools in Shaanxi, Henan, and Shandong Provinces. After this, factor analysis and weighted least squares method were used for the empirical test. Based on theoretical and empirical analysis, this paper found the following: (1) Social networks of adolescents have obvious positive predictive effects on their sports behavior. A single online social network and an offline social network, instrumental network, emotional network, and mixed network have obvious positive predictive effects on adolescent sports behaviors. However, under the influence of multiple types of social networks, an offline social network has a negative predictive effect, while a mixed network has effects that are not as obvious. (2) Social efficacy plays an intermediary role in the relationship between social network and adolescent sports behavior. (3) The moderating effect of self-presentation is not significant.

Objective: Sodium fluorescein (FL) is widely used as a fluorescent tracer for brain tumor resection. However, FL-guided resection of spinal gliomas has been reported only occasionally. To evaluate the safety, characteristics, and usefulness of FL-guided surgery in the resection of spinal glioma. Methods: Between January 2015 and December 2018, 220 consecutive patients with 227 spinal gliomas underwent FL-guided resection using the Zeiss Pentero 900 surgical microscope with an integrated YELLOW 560 filter. FL evaluation and clinical outcomes were analyzed. Results: No FL-related complications occurred in this series. Entire tumor fluorescence was observed in 161 (70.93%) gliomas, nodular fluorescence in 46 (20.26%) tumors, and no fluorescence in 20 (8.81%) tumors. The intraoperative fluorescence of 217 (95.59%) gliomas was highly correlated with preoperative contrast-enhancing magnetic resonance imaging, except in eight ependymomas, one pilocytic astrocytoma, and one diffuse midline glioma. Gross-total resection was achieved in 78.85% (179/227) of spinal gliomas, including 94.30% (149/158) ependymal tumors and 43.48% (30/69) astrocytic and oligodendroglial tumors. At the final clinical follow-up, the spinal function of 75 (33.04%) patients showed significant improvement, 105 (46.26%) showed stabilization, and 47 (20.70%) showed deterioration. Conclusion: FL is a safe and useful real-time tool that could enhance tumor borders or residual tumors and hence increase the gross-total resection rate in cases with contrast-enhanced tumors.

Background Vancomycin is a first-line antibiotic used for the treatment of severe gram-positive bacterial infections. Clinical guidelines recommend that the vancomycin trough concentration be 10-15 mg/L for regular infections and 15-20 mg/L for severe infections. We investigated whether increasing the vancomycin concentration would result in better clinical outcomes with sustainable adverse effects (AEs) in the Chinese population. Methods A prospective, open, multicenter clinical observational study was performed in patients with gram-positive bacterial infections from 13 teaching hospitals. Patients received vancomycin therapeutic drug monitoring. Clinical, microbiological, and laboratory data were collected. Results In total, 510 patients were enrolled, and 470 were evaluable, of whom 370 were adults and 100 were children; 35.53% had methicillin-resistant Staphylococcus aureus infections (vancomycin 50% minimum inhibitory concentration [MIC50] = 1, 90% minimum inhibitory concentration [MIC90] = 1), and 23.19% had Enterococcus species infections (vancomycin MIC50 = 1, MIC90 = 2). The average trough concentration was 10.54 ± 8.08 mg/L in adults and 6.74 ± 8.93 mg/L in children. The infection was eradicated in 86.22% of adults and 96% of children. Thirty-six vancomycin-related nephrotoxicity cases were reported in the enrolled population. No severe AEs or deaths were related to vancomycin therapy. Logistic regression analysis showed that trough concentration had no relationship with clinical outcomes (adults P = .75, children P = .68) but was correlated with adult nephrotoxicity (P < .0001). Vancomycin trough concentration had an applicable cut point at 13 mg/L. Conclusions Our study shows that vancomycin trough concentration has no statistical correlation with clinical outcomes, and is an indicator of nephrotoxicity in the observed population. We found no evidence that increasing vancomycin trough concentration to 15-20 mg/L can benefit Chinese patients with complicated infections. Clinical Trials Registration ChiCTR-OPC-16007920.

Based on the TE01 mode of a rectangular metal waveguide and the Gaussian mode of a fiber, we propose the cos-Gaussian mode of a terahertz rectangular metal waveguide filled with multiple slices of dielectric. First, we consider a rectangular metal waveguide filled with an ideal graded-index dielectric along one direction. Furthermore, we replace the graded-index dielectric with multiple slices of dielectric according to the effective medium theory. The modal field, the effective index, and the coupling efficiency of this waveguide are investigated. It is found that the approximately linearly polarized electric field is Gaussian along one dimensionality and cosine along the other one. In addition, the low loss and high coupling efficiency with a Gaussian beam can be acquired at 0.9 THz. By optimization, the coupling efficiency could reach 88.5%.

A promising and novel electrochemiluminescence (ECL) aptasensor equipped with an electrically heated indium tin oxide (ITO) electrode was constructed. Temperature control was achieved by heating the ITO electrode, avoiding the tedious operation and substantial increase in noise experienced when heating the bulk solution. Using the heated ITO electrode, an order of magnitude improvement in ECL sensitivity was obtained by operating the electrode at 65 °C compared to 25 °C, and this can be used to further enhance the performance of the biosensor. Keywords: Temperature control, Heated indium-tin-oxide electrode, Electrochemiluminescence, Hyperbranched rolling circle amplification, Ochratoxin A

Ecosystem functioning and related risks could become compromised by climate change and severely affect livestock in different ways. Based on four climate indices (i.e., SPI, SPEI, PDSI and SEDI), livestock determinants and biogeochemical proxies, we analysed the temporal and geographical extent of terrestrial ecosystem shift probabilities and drought-wetness risk severity at multiple scales (i.e., land cover, climate and elevation) in the greater Mekong subregion (GMS) during the period 1981–2020 by using different cartographic techniques. The results indicated that in the GMS area, approximately 3.8% experienced the highest ecosystem shift probability, 4% was exposed to a high risk of drought and wetness, and only approximately 55% experienced a low risk of drought and/or wetness stress. Cambodia and Thailand experienced the highest ecosystem shift probability ratio and drought-wetness risk severity compared to other GMS countries. Woody savanna and urban land covers; temperate-fully humid-cold summer and tropical rainfall fully humid climate zones; and elevations −47–200 m and ≥2500 m showed common characteristics leading to a very high ecosystem shift probability and experienced high drought-wetness risk severity. This study provides useful information that may exert to a strong control and improved future terrestrial in the context of changes in climate and biogeophysical aspects at the regional and country scales.

Recently, correlation filter (CF)-based tracking methods have attracted considerable attention because of their high-speed performance. However, distortion, which refers to the phenomenon that the correlation outputs of CF-based trackers are distorted, remains a major obstacle for these methods. In this paper, we propose a distortion-aware correlation filter framework, which can detect distortions and recover from tracking failures. Our framework employs a simple yet effective feature termed normed correlation response to detect distortions. Meanwhile, we introduce a competition mechanism to handle distortions, in which we build a specialized graph to formulate and handle tracking under distortion as a maximum multi clique problem. Furthermore, a global-local context model is exploited to alleviate underlying distortions during the tracking process. Extensive experiments on the Online Tracking Benchmark show that our tracker can find the optimal target trajectory during the distortion period and retrieve the possibly missing target, consequently outperforms the state-of-the-art methods and improves the performance of CF-based trackers favorably.

Plasmon-induced transparency (PIT) is a key addition to mimicking the quantum phenomena of electromagnetically induced transparency (EIT) in atomic systems. So far, various metamaterial structures have been proposed to excite and manipulate the PIT effect. However, most of the reported works were based on 2-D metal structures, and consequently, the PIT phenomena often arise from their electric responses. Here, we propose a novel PIT metamaterial scheme based on three vertically placed split ring resonators (SRRs) working at terahertz frequencies. This stereo structure, with a typical EIT-like transmission, couples to both the electric and magnetic fields of the normally incident wave. We numerically demonstrate that the coupling between the radiative and subradiative elements can be modulated not only by their mutual separation but also by the vertical height of the SRRs. In addition, a classical Fano resonance model is applied to explain the coupling effects of EIT-like transmission spectra, which is in good accordance with the numerical results. Considering the higher design freedom of the stereo metamaterials, our work provides a promising way for PIT metamaterial and terahertz slow light device research.

Spinal ependymomas (SEs) are common adult intramedullary tumors; however, determining the absolute boundary between the tumor and the tumor residual may be difficult.We assessed outcomes following the use of fluorescein sodium (FS) during surgical removal of SEs.We performed a retrospective analysis of 112 patients with SEs who were treated at Beijing Tsinghua Changgung Hospital between December 2014 and December 2016.Each patient received intravenous FS (3-4 mg/kg) to determine the SE boundaries during surgery.Tumor removal efficiencies and tumor residuals were assessed using magnetic resonance imaging (MRI) at 10 days and 3 months after surgical recovery; McCormick's spinal function classification was also performed at the 3-month follow-up.The complete tumor removal rate was 92%(103/112).Ninetyfour patients underwent tumor removal under fluorescent light, which provided distinctive tumor fluorescence.Tumor removal under white light was performed in 18 patients; fluorescent images were invisible or indistinctive in these 18 patients.At the 3-month follow-up, sensory function (85.8%(91/106)) and movement (84.3% (86/102)) were improved in patients with pre-surgical dysfunction; urination and defecation functions were improved in 66.7%(16/24).The McCormick spinal cord functional classifications, at the 3-month follow-up, showed significant differences in the percentages of patients with disease classified to each grade (Ⅰ-Ⅳ), compared with preoperative classifications (each, P < 0.05).There was no MRI evidence of tumor relapse or residuals at the 3-month follow-up.FS use during the surgical treatment of SE enables complete tumor removal and detection of tumor residuals.

Schwannomas are the most common type of spinal tumor, and they most commonly occur in intradural extramedullary locations. Intramedullary schwannomas of the central nervous system are very rare and are difficult to diagnose using preoperative imaging. Here, we report a rare, tiny cervical intramedullary schwannoma and review the literature regarding the clinical presentation, magnetic resonance imaging, pathology, and surgical experience associated with this rare tumor type.

This study explored the combined use of the O-arm and real-time navigation during spinal fixation. The clinical data for 60 patients undergoing spinal fixation, at Beijing Tsinghua Chang Gung Hospital between May 5, 2015 and May 1, 2017, were retrospectively analyzed. Pre-, intra-, and postoperative imaging findings were assessed. The patients were classified into the occipitocervical fusion (32 cases) and thoracic/lumbar/sacral spine fixation (28 cases, including 6 cases of percutaneous pedicle screw) groups. Lesion resections were performed microscopically. An O-arm, combined with real-time navigation, was used to assess spinal fixation. Efficacy was evaluated using operative times, X-ray times, screw positioning, and complications. Within the occipitocervical fusion group, 182 screws were placed in the cervical spine and 96 in the occipital bone. However, 6 screws penetrated the bone cortex and were adjacent to the vertebral arteries, based on O-arm three-dimensional imaging; therefore, the precision rate was 96.7%. Within the thoracic/lumbar/sacral spine fixation group, 148 pedicle screws were implanted, with 4 initially outside the vertebral body, yielding a precision rate of 97.3%. Ten percutaneous pedicle screws were implanted and well positioned. O-arm scans were performed 3 times/patient, with an average of 20-30 min/time. Screw implantation times were 5-7 min (cervical spine), 8-10 min (thoracic spine), and 6-8 min (lumbar spine). Intraoperative O-arm scans, combined with real-time navigation technology, allow real-time observation of screw angles and depths, improving the accuracy and safety of posterior screw fixations and reducing the radiation dose and frequency experienced by patients and surgeons.

Background The accuracy and safety of pedicle screw insertion was markedly improved with the introduction of intraoperative three-dimensional navigation system during the last decade. This study aimed to evaluate the accuracy of pedicle screw placement using O-arm-based navigation system versus conventional freehand technique. Methods We reviewed the accuracy of 341 thoracic (n = 173) and lumbosacral (n = 168) pedicle screws placed in 60 consecutive patients using either O-arm-based navigation or freehand technique in the Department of Neurosurgery of Beijing Tsinghua Changgung Hospital between January 2015 and June 2018. Patient-specific characteristics, treatment-related characteristics, and screw-specific accuracy were analyzed. The accuracy of pedicle screw placement was measured by Gertzbein-Robbins scale and screw grades A and B were clinically acceptable. Results One hundred ninety-one screws were inserted in the O-arm-based navigation group and 150 in the freehand group. One hundred eighty-three (95.81%) clinically acceptable screws were placed in the navigation group and 135 (90.00%) in the freehand group (p = 0.034). Twenty-three (6.74%) screw revisions were performed in the two groups (8 screws in the navigation group and 15 screws in the freehand group) and significant difference was observed in thoracic spine (p = 0.018), while no statistical significance was presented in lumbosacral spine (p > 0.05). Twenty-four (12.57%) screws in the navigation group and 24 (16.00%) in the freehand group violated the cortex (p > 0.05). Medial screw deviation was the most common problem in the two groups. Conclusion The O-arm-based navigation exhibits higher accuracy for pedicle screw insertion than the freehand insertion technique.

Rationale: Clear cell meningioma (CCM) is one of the rarest but most aggressive forms of meningioma, with a tendency to occur at a high recurrence rate. Intraspinal CCM, especially the nondura-based type, is even rarer than the intracranial CCM. Patient concerns: We report a case of a 45-year-old woman who presented with a 1-month history of episodic pain in the lower back and in both thighs in the front side. Femoral nerve stretch tests were positive on both sides. Magnetic resonance imaging (MRI) demonstrated an intradural tumor at the L3 level, which was isointense on T1- and T2-weighted images (WI) and homogeneously enhanced on gadolinium-contrast T1 WI. Diagnoses: The space-occupying lesion was pathologically confirmed as CCM. Interventions: During surgery, we found that the tumor adhered to a nerve root, without dural attachment. The nerve root was partially removed to achieve complete resection. Outcomes: The pain disappeared after the operation. The 1 year follow-up MRI revealed no evidence of tumor recurrence or metastasis. Lessons: Nondura-based intraspinal CCM is easier to completely remove, and such complete removal should be achieved during the first operation. Although the recurrence rate of this particular type of meningioma appears to be lower than that of other types, close clinical and radiological follow-up is necessary.

High-resolution solar absorption spectra, observed by ground-based Fourier Transform Infrared spectroscopy (FTIR), are used to retrieve vertical profiles and partial or total column concentrations of many trace gases. In this study, we present the tropospheric CO2 columns retrieved by mid-infrared solar spectra over Hefei, China. To reduce the influence of stratospheric CO2 cross-dependencies on tropospheric CO2, an a posteriori optimization method based on a simple matrix multiplication is used to correct the tropospheric CO2 profiles and columns. The corrected tropospheric CO2 time series show an obvious annual increase and seasonal variation. The tropospheric CO2 annual increase rate is 2.71 ± 0.36 ppm yr-1, with the annual peak value in January, and CO2 decreases to a minimum in August. Further, the corrected tropospheric CO2 from GEOS-Chem simulations are in good agreement with the coincident FTIR data, with a correlation coefficient between GEOS-chem model and FTS of 0.89. The annual increase rate of XCO2 observed from near-infrared solar absorption spectra is in good agreement with the tropospheric CO2 but the annual seasonal amplitude of XCO2 is only about 1/3 of dry-air averaged mole fractions (DMF) of tropospheric CO2. This is mostly attributed to the seasonal variation of CO2 being mainly dominated by sources near the surface.

As a Rho kinase (ROCK) inhibitor, fasudil has been used in clinical trials of several cardiovascular diseases. This study was to investigate the vasorelaxant effect of fasudil on resistance arterial rings including mesenteric, renal, ventral tail and basilar artery. We also examined the potential mechanisms of its vasodilatory action using mesenteric artery rings. A DMT multiwire myograph system was used to test the tension of isolated small arteries. K(+) channel blockers, NO-cGMP pathway blockers and Ca(2+)-free physiological salt solution (PSS) were employed to verify the underlying mechanisms. Fasudil (10(-7)-10(-4)M) relaxed four types of small artery rings pre-contracted by 60mmol/l KCl (pEC50: 6.01±0.09, 5.47±0.03, 5.54±0.04, and 5.72±0.10 for mesenteric, renal, ventral tail and basilar artery rings, respectively). Pre-incubation with fasudil (1, 3, or 10μmol/l) attenuated KCl (10-60mmol/l) and angiotensin II (Ang II; 1μmol/l)-induced vasoconstriction in mesenteric artery rings. Fasudil at the concentration of 10(-6)mol/l showed different relaxant potency in endothelium intact (pEC50:6.01±0.09) or denued (5.75±0.06) mesenteric artery. The influx and release of Ca(2+) were inhibited by fasudil. In addition, fasudil could block the increased phosphorylation level of myosin light chain (MLC) and myosin-binding subunit of myosin phosphatase (MYPT1) induced by Ang II. However, pretreatment with various K(+) channel blockers did not affect the relaxant effects of fasudil remarkably. The present results demonstrate that fasudil has a vasorelaxant effect on isolated rat resistance arteries, including mesenteric, renal, ventral tail and basilar artery, and may exert its action through the endothelium, Ca(2+) channels, and the Rho/ROCK pathway.

The current therapeutic approaches have a limited effect on the dysregulated pulmonary vascular remodeling, which is characteristic of pulmonary arterial hypertension (PAH). In this study we examined whether salvianolic acid A (SAA) extracted from the traditional Chinese medicine 'Dan Shen' attenuated vascular remodeling in a PAH rat model, and elucidated the underlying mechanisms.PAH was induced in rats by injecting a single dose of monocrotaline (MCT 60 mg/kg, sc). The rats were orally treated with either SAA (0.3, 1, 3 mg·kg(-1)·d(-1)) or a positive control bosentan (30 mg·kg(-1)·d(-1)) for 4 weeks. Echocardiography and hemodynamic measurements were performed on d 28. Then the hearts and lungs were harvested, the organ indices and pulmonary artery wall thickness were calculated, and biochemical and histochemical analysis were conducted. The levels of apoptotic and signaling proteins in the lungs were measured using immunoblotting.Treatment with SAA or bosentan effectively ameliorated MCT-induced pulmonary artery remodeling, pulmonary hemodynamic abnormalities and the subsequent increases of right ventricular systolic pressure (RVSP). Furthermore, the treatments significantly attenuated MCT-induced hypertrophic damage of myocardium, parenchymal injury and collagen deposition in the lungs. Moreover, the treatments attenuated MCT-induced apoptosis and fibrosis in the lungs. The treatments partially restored MCT-induced reductions of bone morphogenetic protein type II receptor (BMPRII) and phosphorylated Smad1/5 in the lungs.SAA ameliorates the pulmonary arterial remodeling in MCT-induced PAH rats most likely via activating the BMPRII-Smad pathway and inhibiting apoptosis. Thus, SAA may have therapeutic potential for the patients at high risk of PAH.