Search

患者女，51岁。有高血压病史，劳累时感腰部酸痛，休息后缓解。体检时B超和腹部增强CT检查发现左肾上腺区占位，行腹腔镜左肾上腺肿瘤切除术，术后病理检查：镜下肿瘤细胞呈梭形，异型性明显，呈疏密交替的束状排列，局部可见血管外皮瘤样结构和地图样坏死；免疫组织化学结果显示：肿瘤细胞H3K27me3表达缺失，S-100蛋白个别细胞阳性，SOX10阴性，横纹肌标志物结蛋白、Myogenin和MyoD1弥漫阳性。荧光原位杂交检测结果显示MDM2基因扩增阴性。本例诊断为肾上腺恶性外周神经鞘膜瘤伴完全性异源性横纹肌母细胞分化（恶性蝾螈瘤），按照法国癌症中心联盟（FNCLCC）分级系统归为3级。患者术后未行放化疗，随访7个月，情况尚良好，复查未见复发转移证据，目前密切随访中。.

Background Increasing evidence suggests that adverse birth outcomes, including preterm birth, small for gestational age (SGA) and large for gestational age (LGA), are associated with increased risks of hypertension, ischemic heart disease, stroke and heart failure. However, knowledge regarding their associations with atrial fibrillation (AF) is limited and inconsistent. Objective To investigate whether preterm birth, SGA and LGA are associated with increased risks of AF later in life. Methods We conducted a population-based cohort study involving 8,012,433 live singleton births based on the nation-wide Danish (1978–2016), Swedish (1973–2014) and Finnish (1987–2014) Medical Birth Registers. Information on birth outcomes, atrial fibrillation and covariates was obtained from nationwide health and socioeconomic registers. We estimated hazard ratios (HR) and 95% confidence intervals (CI) for AF according to preterm birth (90th birth weight for gestational age percentiles, respectively) with multivariable Cox proportional hazard models and flexible parametric survival models. We conducted sibling analyses to control for unmeasured familial risk factors. Results Preterm birth and LGA were associated with increased AF risks in both the full population cohort and in the sibling analyses; the multivariate HRs (95% CI) from the cohort analyses were 1.53 (1.37–1.71) and 1.55 (1.44–1.65), respectively. The associations were stronger with AF in childhood than in adulthood. Children born SGA had an increased risk of AF in the first 18 years of life, but not later. Conclusions Individuals born preterm or LGA had an increased AF risk independently of familial confounding factors. Individuals born SGA had an increased AF risk only during childhood. Persons born prematurely or with abnormal foetal growth may benefit from early screening and prevention to reduce the risk of AF later in life. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swedish Council for Working Life and Social Research; China Scholarship Council

Charge exchange has been recognized as a primary source of soft X-ray emission in many astrophysical outflow environments, including cometary and planetary exospheres impacted by the solar wind. Some models have been set up by using different data collections of charge-exchange cross-sections. However, multiple-electron transfer has not been included in these models. In this paper, we set up a charge-exchange model with the inclusion of double-electron capture (DEC), and make a detailed investigation of this process on X-ray emissions of highly charged carbon, nitrogen, oxygen, and neon ions by using available experimental cross-sections. We also study the effect of different n-selective cross-sections on soft X-ray emission by using available experimental n-distributions. This work reveals that DEC enhancement on line intensity is linearly proportional to the ratio of ion abundance in the solar wind. It is more obvious for soft X-rays from carbon ions (C4+) in collision with CO2, and the enhancement on line intensity can be up to 53 per cent with typical ion abundances [Advanced Composition Explorer (ACE)] in the solar wind. The synthetic spectra with parameters from the Ulysses mission for the solar wind reveal velocity dependence, target dependence, as well as the non-negligible contribution from the DEC.

The New Robotic Telescope (NRT) is an international collaboration to build and operate a 4m diameter fully robotic telescope. The telescope will take advantage of the superb atmospheric conditions at the Observatory of the Roque de los Muchachos (ORM). In conjunction with a large aperture, entirely robotic operation, quick response, and a set of versatile instrumentation in the optical and near-infrared this guarantees a high scientific impact focused mainly in the area of time domain astronomy. This paper presents the scientific motivation and the status of the project, discussing possible technical solutions under evaluation for the optics, mechanics and control system.

Commercial all-electric aircraft are projected to be flying as early as 2035, where hydrogen is selected to supply fuel and coolant. The cryogenic aircraft's powertrain includes the turbines, generators, power electronics and fan motors. As most of the powertrain is located at cryogenic temperature, it is preferable to co-locate the power electronics in the same region to reduce the engineering system's complexity. Silicon super-junction MOSFETs are known for their high efficiency, thus lower cooling requirements at cryogenic temperature. However, in phase-leg circuits, the behaviour of the MOSFET's intrinsic diode, and its output capacitance are challenging. These issues can be addressed by using the MOSFET with ancillary power devices to realise diode deactivation. This paper compares different permutations of intrinsic diode deactivation devices at room temperature and cryogenic temperature. The paper presents a demonstrator phase-leg built with different ancillary power devices. It is operated from a DC voltage of 270 V, and supplies a phase current of up to 10 A.

OBJECTIVE: To study the trend of surgical type, surgical procedure and etiological distribution of upper urinary tract repair in recent 10 years. METHODS: The preoperative and perioperative variables and follow-up data of upper urinary tract reconstruction surgery in RECUTTER (Reconstruction of Urinary Tract: Technology, Epidemiology and Result) database from 2010 to 2021 were searched, collected and analyzed. The surgical type, surgical procedure, duration of hospitalization, time of operation, incidence of short-term complications, and proportion of the patients undergoing reoperations were compared between the two groups of 2010-2017 period and 2018-2021 period. RESULTS: A total of 1 072 patients were included in the RECUTTER database. Congenital factors and iatrogenic injuries were the main causes of upper urinary tract repair. Among them, 129 (12.0%) patients had open operation, 403 (37.6%) patients had laparoscopic surgery, 322 (30.0%) patients had robot-assisted laparoscopic surgery and 218 (20.3%) patients had endourological procedure. In the last decade, the total number of surgeries showed a noticeable increasing annual trend and the proportion of robot-assisted laparoscopic surgery in 2018-2021 was significantly higher than that in 2010-2017 (P < 0.001). The 1 072 patients included 124 (11.6%) cases of ileal ureter replacements, 440 (41.1%) cases of pyeloplasty, 229 (21.4%) cases of balloon dilation, 109 (10.2%) cases of ureteral reimplantation, 49 (4.6%) cases of boari flap-Psoas hitch surgery, 60 (5.6%) cases of uretero-ureteral anastomosis, 61 (5.7%) cases of lingual mucosal onlay graft ureteroplasty or appendiceal onlay flap ureteroplasty. Pyeloplasty and balloon dilatation had been the main types of surgery, while the proportion of lingual mucosal onlay graft ureteroplasty plus appendiceal onlay flap ureteroplasty had increased significantly in recent years (P < 0.05). In addition, the time of operation was significantly increased (P < 0.05) after 2018, which was considered to be related to the sharp increase in the proportion of robot-assisted laparoscopic surgery. We found that minimally invasive surgery (endourological procedure and robot-assisted laparoscopic surgery) as an independent risk factor (P=0.050, OR=0.472) could reduce the incidence of short-term post-operative complications. CONCLUSION: We have justified the value of the RECUTTER database, created by the Institute of Urology, Peking University in data support for clinical research work, and provided valuable experience for the construction of other multi-center databases at home and abroad. In recent 10 years, we have observed that, in upper urinary tract reconstruction surgery, the surgery type tends to be minimally invasive and the surgery procedure tends to be complicated, suggesting the superiority of robot-assisted laparoscopic surgery.

BACKGROUND AND PURPOSE: Microstructural white matter abnormalities on DTI using Tract-Based Spatial Statistics at term-equivalent age are associated with cognitive and motor outcomes at 2 years of age or younger. However, neurodevelopmental tests administered at such early time points are insufficiently predictive of mild-moderate motor and cognitive impairment at school age. Our objective was to evaluate the microstructural antecedents of cognitive and motor outcomes at 3 years' corrected age in a cohort of very preterm infants. MATERIALS AND METHODS: We prospectively recruited 101 very preterm infants (

乙型肝炎病毒感染及相关肝硬化少见并发严重的坏死性肌病。本文报道1例58岁男性患者，主诉为HBsAg阳性伴转氨酶异常30年，进行性周身乏力、四肢运动障碍2个月，入院后首先考虑乙型肝炎肝硬化所致周身乏力等症状，并予以抗病毒、保肝及对症支持等治疗，病情未见明显好转。进一步行血清肌炎抗体谱、四肢肌肉磁共振成像及肌肉组织病理学检查，明确诊断为乙型肝炎肝硬化合并坏死性肌病，结合患者2个月前有昆虫叮咬史，考虑为昆虫叮咬所释放毒素诱发了机体异常免疫反应，在抗病毒及保肝治疗基础上，联合应用糖皮质激素及人免疫球蛋白，坏死性肌病逐渐康复，继续应用抗病毒药物。当慢性乙型肝炎病毒感染及肝硬化患者出现进行性周身乏力、运动障碍等肌肉损伤症状时，应进行免疫性肌损伤等相关检查，以明确病因，及时救治。.

OBJECTIVE: To compare the clinical effect of microsurgery and endovascular embolization in the treatment of spinal dural arteriovenous fistula (SDAVF) by meta-analysis. METHODS: A systematic review was performed to retrieve all relevant literature about surgical treatment or endovascular embolization of SDAVF up to December 2019 through PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials Results, CNKI, Wanfang Data, and SinoMed. The Chinese and English key words included: "SDAVF", "spinal dural arteriovenous fistula", "spinal AVM", "spinal vascular malformation and treatment". The included studies were evaluated using the Newcastle-Ottawa scale. The early failure rate, long-term recurrence, neurological recovery, and complications were evaluated and the clinical effects of the two methods in the treatment of SDAVF were compared by using RevMan 5.3 software. And a further subgroup analysis of the therapeutic effect of endovascular embolization with different embolic agents was conducted. RESULTS: A total of 46 studies involving 1 958 cases of SDAVF were included, in which 935 cases were treated by microsurgery and 1 023 cases were treated by endovascular embolization. The funnel plot demonstrated that there was no publication bias. The results of meta-analysis showed that the incidence of early surgical failure was lower than that of endovascular embolization (OR=0.20, 95%CI: 0.13-0.30, P < 0.05), and the long-term recurrence was also lower than that of endovascular embolization (OR=0.36, 95%CI: 0.22-0.58, P < 0.05). The improvement of neurological function in the surgical patients is significantly higher than that in the patients treated with endovascular embolization (OR=2.86, 95%CI: 1.36-5.99, P < 0.05). There was no significant difference in the occurrence of complications in these two groups (OR=1.52, 95%CI: 0.88-2.64, P=0.14). In the cases of endovascular embolization, the risk of treatment failure or recurrence was higher with Onyx glue than with n-butyl 2-cyanoacrylate (NBCA), and the difference was statistically significant (OR=4.70, 95%CI: 1.55-14.28, P < 0.05). CONCLUSION: Although the treatment of dural arteriovenous fistulas by intravascular embolization has been widely used, the clinical effect of microsurgery is still better than that of endovascular embolization. Large scale and high-quality randomized controlled trials are required to validate the efficacy and safety of endovascular treatment in SDAVF patients.

The vibro–acoustic strong coupling problem between the panel and cavity widely exists in the industry. This paper developed a numerical method to study the natural characteristics and vibro–acoustic response of the strong coupling system with an elastically restrained rectangular plate backed by a trapezoidal cavity. The isoparametric transformation technique was used to normalize the trapezoidal cavity. The dynamical equations of the coupling system were derived using the energy principle and the Rayleigh–Ritz method with the Legendre polynomial series as trial functions. Then, the effects of structural boundary conditions and bevel angle on the natural frequencies of the system with the elastic plate on the top surface of the trapezoidal cavity were explored. The natural frequency increased with the number of structural support boundaries and the inclination angle of the trapezoidal cavity bevel. Besides, the steady-state response of the coupling system under different excitation conditions was investigated. Therefore, accurate prediction for steady-state response will provide ideas for noise control of the vibro–acoustic strong coupling problem.

This article presents a novel decoupling technique for the circularly polarized multiple-inputmultiple- output (CP-MIMO) system composed of Guoshaped patch antennas. A comparative study has been conducted on antenna performance as a function of packing distance before and after applying the technique. A prototype of two-element Guo-shaped patch MIMO at a small inter-element spacing of 12.5 mm has devised aiming for the 5G new radio n38 (2.57-2.62 GHz) applications. Simulation reinforced with experimental results confirmed the effectiveness of the proposed technique, whereas the two Guo-shaped patch elements packed in such small spacing can be operated independently. Both the envelope correlation coefficient and diversity gain are approaching their ideal values.

Soft x-ray emissions induced by solar wind ions that collide with neutral material in the solar system have been detected around planets, and were proposed as a remote probe for the solar wind interaction with the Martian exosphere. A multi-fluid three-dimensional magneto-hydrodynamic model is adopted to derive the global distributions of solar wind particles. Spherically symmetric exospheric H, H$_2$, He, O, and CO$_2$ density profiles and a sophisticated hybrid model that includes charge-exchange and proton/neutral excitation processes are used to study the low triplet line ratio $G=\frac{i+f}{r}$ (0.77$\pm$0.58) of O VII and total x-ray luminosity around Mars. We further calculate the emission factor $\alpha$-value with different neutrals over a wide ion abundance and velocity ranges. Our results are in good agreement with those of previous reports. The evolution of the charge stage of solar wind ions shows that sequential recombination due to charge-exchange can be negligible at the interaction region. This only appears below the altitude of 400~km. The anonymous low disk $G$ ratio can be easily explained by the collisional quenching effect at neutral densities higher than 10$^{11}$cm$^{-3}$. However, the quenching contribution is small in Mars' exosphere and only appears below 400~km. Charge-exchange with H$_2$ and N$_2$ is still the most likely reason for this low $G$-ratio. X-ray emissivity maps in collisions with different neutrals differ from each other. A clear bow shock in the collision with all the neutrals is in accordance with previous reports. The resulting total x-ray luminosity of 6.55~MW shows a better agreement with the XMM-Newton observation of 12.8$\pm$1.4~MW than that of previous predictions., Comment: 17 pages, 13 figures; Accpted by ApJ

There is a wide range of clinical and radiographic factors affecting individual surgeons' ultimate decision for CSF diversion for pediatric patients following prenatal myelomeningocele repair. Our aim was to construct a composite index (CSF diversion surgery index) that integrates conventional clinical measures and neuroimaging biomarkers to predict CSF diversion surgery in these pediatric patients.This was a secondary retrospective analysis of data from 33 patients with prenatal myelomeningocele repair (including 14 who ultimately required CSF diversion surgery). Potential independent variables, including the Management of Myelomeningocele Study Index (a dichotomized variable based on the shunt-placement criteria from the Management of Myelomeningocele Study), postnatal DTI measures (fractional anisotropy and mean diffusivity in the genu of the corpus callosum and the posterior limb of internal capsule), fronto-occipital horn ratio at the time of DTI, gestational ages, and sex, were evaluated using stepwise logistic regression analysis to identify the most important predictors.The CSF diversion surgery index model showed that the Management of Myelomeningocele Study Index and fractional anisotropy in the genu of the corpus callosum were significant predictors (The CSF diversion surgery index model outperformed all single predictor models and, with additional validation, may potentially be developed and incorporated into a sensitive and robust clinical tool to assist clinicians in hydrocephalus management.

Journal of high energy physics 2020(8), 146 (2020). doi:10.1007/JHEP08(2020)146, Published by SISSA, [Trieste]

The hexagonal boron nitride (h-BN) as a wide bandgap semiconductor is an attractive material for deep ultraviolet (DUV) generation. In this paper we study the prospect of using the stacking hexagonal boron nitride nanosheets (h-BNNS) for generating DUV emission by impact excitation in alternating current driven thin electroluminescence devices (ACTEL) based on BN phosphors having different morphologies. A theoretical approach considered is based on the impact excitation model for generating DUV from stacking h-BNNS under a high electric field. It was found that in the h-BNNS with a thickness of 90 nm biased at 3.33×109 V/m, the quantum yield can reach to 86.8%, and the power conversion efficiency of 1.68%. To achieve the same quantum yield and power conversion efficiency for the ACTEL based on h-BN single crystal, the active phosphor layer should be 2 μm thick when biased at 1.5×108 V/m.

As a novel X-ray focusing technology, lobster eye micro-pore optics (MPO) feature both a wide observing field of view and true imaging capability, promising sky monitoring with significantly improved sensitivity and spatial resolution in soft X-rays. Since first proposed by Angel (1979), the optics have been extensively studied, developed and trialed over the past decades. In this Letter, we report on the first-light results from a flight experiment of the Lobster Eye Imager for Astronomy ($LEIA$), a pathfinder of the wide-field X-ray telescope of the Einstein Probe mission. The piggyback imager, launched in July 2022, has a mostly un-vignetted field of view of $18.6^\circ \times 18.6^\circ $. Its spatial resolution is in the range of 4$-$7 arcmin in FWHM and the focal spot effective area is 2$-$3 cm$^2$, both showing only mild fluctuations across the field of view. We present images of the Galactic center region, Sco X-1 and the diffuse Cygnus Loop nebular taken in snapshot observations over 0.5$-$4 keV. These are truly wide-field X-ray images of celestial bodies observed, for the first time, by a focusing imaging telescope. Initial analyses of the in-flight data show excellent agreement between the observed images and the on-ground calibration and simulations. The instrument and its characterization are briefly described, as well as the flight experiment. The results provide a solid basis for the development of the present and proposed wide-field X-ray missions using lobster eye MPO., Comment: 11 pages, 4 figures. Accepted for publication in Astrophysical Journal Letter