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BACKGROUND Uretero-arterial fistula (UAF) is a disease that usually involves the aorta, common iliac artery, external iliac artery, hypogastric artery, and lumbar artery. Among them, uretero-lumbar artery fistula (ULAF) is the most unusual type. So, both in China and around the world, the diagnosis and treatment of ULAF is a big challenge. CASE SUMMARY A 55-year-old female patient with a history of pelvic radiotherapy developed unexplained massive hemorrhage during replacement of the right Resonance metallic ureteral double-J tubes due to a long-standing indwelling ureteral stent for ureteral stricture. Later, we found contrast extravasation from the patient's right L4 artery into the ureter under digital subtraction angiography (DSA) and administered polyvinyl alcohol particle embolic agent and coil embolization; hematuria was controlled. Follow-up investigations at 18 mo showed no sign of recurrence. CONCLUSION DSA is very important in the diagnosis and treatment of UAF, and DSA should be preferred when UAF is suspected. In addition, the use of softer ureteral stents in patients with primary disease and risk factors for UAF should be considered to avoid increasing the risk of the development of the disease; endovascular treatment should be preferred in patients who have developed UAF.

This article proposes a novel approach to handle macro placement. Previous works usually apply the simulated annealing (SA) algorithm to handle this problem. However, the SA-based approaches usually have difficulty in handling preplaced macros and require longer runtime. To resolve these problems, we propose a macro placement procedure based on the corner stitching data structure and then apply an efficient and effective simulated evolution algorithm to further refine placement results. In order to relieve local routing congestion, we propose to expand areas of movable macros according to the design hierarchy before applying the macro placement algorithm. Finally, we extend our macro placement methodology to consider dataflow constraint so that dataflow-related macros can be placed at close locations. The experimental results show that our approach obtains a better solution than a previous macro placement algorithm and a tool. Besides, placement quality can be further improved when the dataflow constraint is considered.

Penile dorsal nerve somatosensory evoked potential (DNSEP) is a scientific and objective technique that provides effective and objective data to establish the diagnosis of premature ejaculation (PE).To explore differences in DNSEP between patients with primary premature ejaculation (PPE) and those with secondary premature ejaculation (SPE), in order to investigate the clinical value of DNSEP in the diagnosis of PE.The participants were divided into a PPE group (34 cases), an SPE group (25 cases) and a healthy control group (18 cases). All participants underwent DNSEP testing, and the latencies and amplitudes of DNSEP were recorded.Differences in the latencies and amplitudes of DNSEP were compared among the PPE, SPE, and healthy control groups.The latencies of DNSEP in the PPE and SPE groups were shorter than those in the healthy control group, and these differences were statistically significant (P0.01). However, there was no statistically significant difference between the PPE and SPE groups (P0.05). The amplitudes of DNSEP in the PPE group were significantly higher than those in the healthy control group (P0.01). However, the amplitudes of DNSEP in the SPE group were significantly lower than those in the healthy control group (P0.05).PPE and SPE can be differentiated based on differences in the amplitudes of DNSEP, providing an objective basis for treatments and follow-up examinations.We evaluated differences in the amplitudes of DNSEP between PPE and SPE patients, which were rare in the published literature. However, specific causes of these differences are still unclear. SEP only reflects afferent pathways in the ejaculatory reflex arc, and role of the brain as a higher center should not be ignored.Both PPE and SPE patients are characterized by an increased excitability of the penile sensory nerves. Sun Z, Liao Z, Zheng Q, et al. A Study of Differences in Penile Dorsal Nerve Somatosensory Evoked Potential Testing Among Healthy Controls and Patients With Primary and Secondary Premature Ejaculation. J Sex Med Rev 2021;18:732-736.

Purpose: To compare the time-varying recurrence patterns of different molecular subtypes of breast cancer in the contemporary era with those in the past era. Methods: This retrospective study included 14627 consecutive invasive breast cancer patients who underwent surgery from 2008 to 2016 at Fudan University Shanghai Cancer Center. We defined the period from 2013 to 2016 as the contemporary era and that from 2008 to 2012 as the past era. Five subtypes were defined according to the immunohistochemistry results. Emphasis was made on the changing patterns of recurrence for patients with different molecular subtypes changed between the two treatment eras. Kaplan–Meier survival curves were generated, and the hazard function was used to estimate the annual recurrence hazard. Results: By the end of follow-up (median, 68.1 months), 1429 patients (9.77%) experienced recurrence and metastasis. The annual recurrence risks of the entire population and each molecular type in 2013-2016 were reduced compared with those in 2008-2012. Luminal A and triple-negative patients in 2013-2016 showed a significantly lower recurrence hazard curve than those in 2008-2012. The recurrence hazard curve of luminal B (HER2-) and HER2+ subtypes was lower in 2013-2016 than in 2008-2012. The recurrence risk of the luminal B (HER2+) subtype was reduced substantially during 2013-2016, showing a delay of two years.Conclusion: With early detection of disease recurrence and improved treatment strategies, the recurrence patterns of different molecular subtypes of breast cancer have changed. The time-varying recurrence patterns observed during the contemporary era are significant for treatment decision-making and clinical trial planning.

Background Paratesticular liposarcoma accounts for approximately 7% of scrotal tumors. They are rare lesions of the reproductive system with approximately 90% of the lesions originating from the spermatic cord. Surgery, with the goal of complete resection, is the mainstay for treatment of this disease. However, treatment consisting of extended resection to decrease local recurrence remains controversial. Case summary We report the cases of two patients with paratesticular liposarcomas who were treated with radical testicular tumor resection without adjuvant therapy. Follow-up investigations at 9 mo showed no sign of recurrence. Conclusion Surgery is the first-line treatment, regardless of whether it is a recurrent or primary tumor. Extended resection carries a higher risk of complications and should not be performed routinely. Preoperative radiotherapy can reduce the local recurrence rate without affecting the overall survival.

We report 4th order colliding pulse mode-locked laser based on InAs/GaAs QD structure, which can generate ultra-stable optical frequency combs in O-band with 100 GHz spacing and a record-high 3 dB optical bandwidth of 11.5 nm (20 comb lines) at 25 °C. Single channel NRZ modulation rates of 70 Gb/s and PAM-4 of 40 GBaud/s are also demonstrated.

In this study, the effect of polishing brick powder replacement cement slurry method on water absorption of motar is discussed. A series of mortar samples are prepared for testing water penetration amount at unit surface area with square of time and permeable porosity. The results show that the replacement of cement slurry with polished brick powder will increase the permeable pore of mortar and increase the sorptivity per unit area, thus effectively reducing the sorptivity of mortar at the same water cement ratio or strength.

Shortage of river sand and disposal of stone sludge are the problem of the construction and stone product industries, respectively. Utilization of stone sludge in mortar is one of the feasible strategies to solve these two problems. To study the effects of addition of stone sludge on the performance of mortar, 20 mixes of stone sludge powder mortar with various water/cement ratios and various stone sludge powder contents were produced for flowability measurement. To further study the governing mechanism of flowability and the packing densities of the solid proportions of the 20 mortar mixes were measured. Based on the packing density results, the average film thickness (AFT) of the 20 mortar mixes were calculated for flowability indication. Results proved that addition of stone sludge powder as sand replacement would decrease the flowability. The flowability was mainly governed by the AFT.

The realization of monolithic integration of a stable III–V laser on a standard silicon-on-insulator (SOI) substrate has been regarded as a challenging technology for silicon-based photonic integration circuits (PICs). Here, we successfully demonstrated the electrically pumped P-doped 1300 nm InAs/GaAs quantum dot (QD) laser epitaxially grown on {111}-faceted SOI hollow substrates. These III–V QD lasers, which are epitaxially grown on an SOI substrate, generally exhibit strong thermal accumulation due to the oxide layer underneath. By applying a double-side heat dissipation design, the maximum operation temperature of the SOI-based InAs/GaAs QD laser under a continuous-wave (CW) operation mode is ramped up to 35°C from 20°C. Moreover, the thermal profile simulation of three different structures has also been carried out to show the effectiveness of the top heat sink design in order to improve laser performance. An integrated thermal shunt design is proposed to improve heat dissipation without using the external top heat sink. The successful realization of room-temperature SOI-based InAs/GaAs QD lasers pave a viable way for integrating light sources in PICs.

Quantum dot lasers on silicon have gained significant interest over the past decade due to their great potential as an on-chip silicon photonic light source. Here, we demonstrate multi-wavelength injection locking of InAs/GaAs quantum dot Fabry–Perot (FP) lasers both on GaAs and silicon substrates by optical self-injection via an external cavity. The number of locked laser modes can be adjusted from a single peak to multiple peaks by tuning wavelength dependent phase and mode spacing of back-injected light through a Lyot filter. The multi-wavelength injection locked laser modes exhibit average optical linewidth of ∼ 20 kHz , which are narrowed by approximately three orders of magnitude from their free-running condition. Furthermore, multi-wavelength self-injection locking via an external cavity exhibits flat-top optical spectral properties with approximately 30 stably locked channels under stable operation over time, where the frequency detuning is less than 700 MHz within 40 min. Particularly, FP lasers by direct epitaxial growth on silicon substrates are self-injection locked as a flat-top comb source with tunable free spectral range from approximately 25 to 700 GHz. The reported results emphasize the great potential of multi-wavelength injection locked lasers as tunable on-chip multi-wavelength light sources.

BACKGROUND: The visualization of microvasculature is an essential step in understanding the mechanisms underlying early vessel disorders involved in breast cancer and for developing effective therapeutic strategies. However, generating detailed and reproducible data using immunohistochemistry analysis of breast cancer angiogenesis has been difficult. METHODS: To analyze the diversification of angiogenesis in the development of tumor growth and evaluate the anti-vascular effects of Avastin (bevacizumab), we used new X-ray microangiography and third-generation synchrotron radiation-based micro-computed tomography (SR micro-CT) technology. With these techniques, we were able to investigate the structures and density of microvessels in xenograft mouse models (n=24). Barium sulfate nanoparticles were injected into the left cardiac ventricle of the mice to allow the visualization of blood vessels. RESULTS: Three-dimensional structures of microvessels were displayed with a high spatial image resolution of 20–30 µm. The density of angiogenesis and the incidence of lung metastasis were significantly reduced in xenograft mouse models of breast cancer treated with Avastin compared with control groups. Also, the density of smaller vessels (diameter 100 µm) was not significantly changed. CONCLUSIONS: Avastin inhibited tumor growth and lung metastasis by reducing microvessels. Additionally, synchrotron radiation (SR) techniques are useful as an additional tool for more precise quantification of angiogenesis.

A quantum dot (QD) mode-locked laser as an active comb generator takes advantage of its small footprint, low power consumption, large optical bandwidth, and high-temperature stability, which is an ideal multi-wavelength source for applications such as datacom, optical interconnects, and LIDAR. In this work, we report a fourth-order colliding pulse mode-locked laser (CPML) based on InAs/GaAs QD gain structure, which can generate ultra-stable optical frequency combs in the O-band with 100 GHz spacing at operation temperature up to 100°C. A record-high flat-top optical comb is achieved with 3 dB optical bandwidth of 11.5 nm (20 comb lines) at 25°C. The average optical linewidth of comb lines is measured as 440 kHz. Single-channel non-return-to-zero modulation rates of 70 Gbit/s and four-level pulse amplitude modulation of 40 GBaud/s are also demonstrated. To further extend the comb bandwidth, an array of QD-CPMLs driven at separate temperatures is proposed to achieve 36 nm optical bandwidth (containing 60 comb lines with 100 GHz mode spacing), capable of a total transmission capacity of 4.8 Tbit/s. The demonstrated results show the feasibility of using the QD-CPML as a desirable broadband comb source to build future large-bandwidth and power-efficient optical interconnects.

This work demonstrated the first electrically pumped ground-state InAs QD narrow ridge lasers emission at 1310 nm (O-band) epitaxially grown on standard SOI substrate with continuous-wave (CW) current injection at room temperature.

Background: Flavonoids are compounds with 2-phenylchromone as the basic mother nucleus and are natural antioxidant components of Lysimachia christinae. We previously demonstrated that total flavonoids from L. christinae (TFL) reduce calcium and oxalic acid concentrations in urine and can reduce oxidative stress (OS) in renal tissue, thus, inhibiting calcium oxalate (CaOx) stone formation. The aim of this study was to investigate whether TFL reduced OS in renal tissue, thereby inhibiting CaOx stone formation through the nuclear factor-E2 related factor 2 (Nrf2)/antioxidant response element (ARE) pathway.Methods: The rat model of CaOx stone was established by providing rats with drinking water containing 0.5% glycol and 2% ammonium chloride. After 4 weeks of treatment with different doses of TFL (62.5, 125, and 250 mg/kg/d), body and kidney weights of the rats were measured. CaOx crystal formation was observed under the microscope and the renal tissue contents of superoxide dismutase (SOD) and malondialdehyde (MDA) were analyzed. HK-2 cells were divided into two groups: treatment with CaOx crystals or CaOx crystals + TFL. Other HK-2 cells were treated with small interfering RNA targeting nuclear factor-E2 related factor 2 (Nrf2) and divided into the same two groups. The activities of SOD and content of MDA were measured. The expression of Nrf2, heme oxygenase (HO-1), and NAD(P)H quinone oxidoreductase 1 (NQO-1) were detected using western blot.Results: In the in vitro study, TFL significantly increased nuclear Nrf2 and expression of the downstream antioxidant genes, HO-1 and NQO-1. Furthermore, TFL increased superoxide dismutase activity and decreased the malondialdehyde content, thereby alleviating OS in renal tubular epithelial cells. Moreover, silencing the expression of Nrf2 blocked the protective effect of TFL on CaOx-induced OS. In the in vivo study TFL protected the renal cell line and renal tissue against injury, reduced CaOx-induced OS in renal tissue, and reduced CaOx crystal formation.Conclusions: TFL reduces CaOx-induced OS in renal tissue by activating the nuclear Nrf2/antioxidant response element (ARE) pathway.

Oxidative stress (OS) in renal tubular epithelial cells (RTECs) is induced by calcium oxalate (CaOx) stones and plays an important role in the pathology of CaOx nephrolithiasis. The nuclear factor-E2-related factor 2 (Nrf2)/antioxidant response element (ARE) pathway is an important endogenous antioxidant pathway. Flavonoids are compounds with 2-phenylchromone as the basic mother nucleus and are natural antioxidant components of Lysimachia christinae. Our previous studies demonstrated that the total flavonoids from L. christinae (TFL) reduced calcium and oxalic acid concentrations in urine, thus inhibiting CaOx stone formation. We also showed that TFL can reduce OS in renal tissue. However, whether TFL inhibit the formation of CaOx stones through the Nrf2/ARE pathway requires further investigation. Here, we found that TFL protected against injury to a renal cell line and renal tissue, reduced CaOx-induced OS in renal tissue, and reduced CaOx crystal formation. In addition, TFL significantly increased nuclear Nrf2 and the expression of the downstream antioxidant genes heme oxygenase 1 (HO-1) and NAD(P)H quinone oxidoreductase 1 (NQO-1). Furthermore, TFL increased superoxide dismutase (SOD) activity and decreased the malondialdehyde (MDA) content, thereby alleviating OS in RTECs. Silencing Nrf2 expression blocked the protective effect of TFL on CaOx-induced OS. Taken together, our findings indicate that TFL reduce CaOx-induced OS in renal tissue by activating the Nrf2/ARE pathway.

To research the effect of talcum powder and water film thickness on performance of mortar, this study measured the flowability and strength of 25 mixes of cement-sand mortar with different water/binder ratio. To reveal the role of WFT in the flowability of mortar, this research measured packing density of 5 different powder mixes with various talcum powder content, calculated the WFT of the 25 mixes of cement-sand mortar. Results proved that addition of talcum powder improve the flow properties of cement mortar. Packing density results showed that with the increase of the amount of talcum powder, the packing density will increase first and then decrease. The flowability was mainly governed by WFT. Talcum content would also affect the flowability of mortar. The increase of talcum content would improve the flowability of mortar.

In order to study crack evolution in concrete, Electronic Speckle Pattern Interferometry (ESPI) technique was applied to measure full-field displacement of concrete beam subjected to three-point bending. Basic principles of ESPI technique were introduced. Mid-span deflection and crack mouth opening displacement were measured by linear variable differential transformers (LVDTs) and clip gauge, respectively. Typical load-displacement curves measured by different methods were compared and analyzed. Analysis results indicated that ESPI results were in good agreement with that measured by LVDT (clip gauge), verifying the validity and accuracy of ESPI measurement. From displacement contours, crack evolution including its initiation and propagation was observed. Furthermore, strain profiles near the crack at different loading levels were determined. Strain profile was nearly linear before crack initiation and became nonlinear with crack growth.

The present study was conducted to evaluate the radiological findings, particularly the ultrasonographic (US) characteristics of sclerosing adenosis (SA), and their correlation with histopathological results. A retrospective review identified 191 patients with a total of 200 lesions histopathologically confirmed as SA following breast surgery between July 2009 and December 2012. Of the 191 patients, 145 (151 lesions) with SA as the major component were included for US and mammographic (MG) analysis. All 145 patients analyzed were female, with a mean age ± standard deviation of 46.8±7.8 years (range, 25-71 years). All 145 patients underwent US examination and the imaging findings included heterogeneously echogenic areas in 9.3% (14/151), masses in 51.7% (78/151), masses with calcifications in 13.9% (21/151), focal acoustic shadowing in 4.0% (6/151) and were negative in 21.2% (32/151) patients. Among the 119 lesions with visible abnormalities, 87.4% (104/119) were hypoechoic, 58.0% (69/119) were irregular in shape, 52.1% (62/119) had an ill-defined margin, calcifications were found in 17.6% (21/119) and 7.6% (9/119) were hypervascular, while none of the characteristics mentioned above were significantly correlated with histopathology. A total of 136 patients underwent MG at the Fudan University Shanghai Cancer Center, and the imaging findings included microcalcifications in 31.6% (43/136), masses in 23.5% (32/136), asymmetric focal density in 14.7% (20/136), focal architectural distortion in 22.8% (31/136), and were negative in 7.4% (10/136). The mass lesions were fewer on MG compared with US (23.5 vs. 65.6%, respectively). The area under the curve of US distinguishing between benign and malignant lesions was significantly larger compared with that of MG (0.547 vs. 0.497, respectively; P=0.036). In the 60 lesions that were overestimated by Breast Imaging Reporting and Data System US category, one or more characteristics of malignancy were found on US imaging. The most common finding of SA was masses with or without calcifications on US and microcalcifications on MG. The accuracy of US was limited, but higher compared with that of MG; however, SA mimicking the characteristics of malignancy may contribute to misdiagnosis with US.

Background: Since mastectomy remained the primary strategy for treating breast cancer in China, post-mastectomy reconstruction is of great importance in the Chinese population. The current study aimed to assess the current status of breast reconstruction in China. Methods: We reviewed all patients who received breast reconstruction from August 2000 to July 2015 in the Department of Breast Surgery in our institute. Patients’ baseline characteristics, reconstruction strategy, final pathology and loco-regional recurrence (LRR) information were collected. Results: A total of 951 breast reconstructions were conducted during the past 15 years, among which 247 (27.0%) were abdominal flap reconstruction; 471 (51.5%) were latissimus dorsi myocutaneous ± implant; and 233 (25.5%) were prosthesis-based reconstruction. The majority of cases (78.1%) were invasive breast cancer and up to 894 cases (94.0%) were immediate reconstruction. Prosthesis-based reconstruction rapidly increased in recent years, and was associated with bilateral reconstruction, contralateral augmentation and higher complications. 18 patients (2.0%) developed local-regional recurrence at the median follow-up time of 26.6 months (range, 3.7–62.0 months). A total of 66 nipple-areolar complex-sparing mastectomies (NSMs) (6.9%) were performed, none of which developed recurrence. Conclusions: Breast reconstruction cases increased over the 15 years with the change of paradigm. Most strikingly, prosthesis-based reconstruction rapidly gained its prevalence and became the most common strategy. NSM was only performed for highly selected patients. Patients with breast reconstruction were able to achieve satisfactory loco-regional control in our cohort.

We have developed a new nomogram to predict the probability of a patient with 1–2 metastatic sentinel lymph nodes (SLNs) to present further axillary disease. Data were collected from 480 patients who were diagnosed with 1–2 positive lymph nodes and thus underwent axillary lymph node dissection between March 2005 and June 2011. Clinical and pathological features of the patients were assessed with multivariable logistic regression. The Shanghai Cancer Center Non-SLN nomogram (SCC-NSLN) was created from the logistic regression model. This new model was subsequently applied to 481 patients from July 2011 to December 2013. The predictive accuracy of the SCC-NSLN nomogram was measured by calculating the area under the receiver operating characteristic curve (AUC). Based on the results of the univariate analysis, the variables that were significantly associated with the incidence of non-SLN metastasis in an SLN-positive patient included lymphovascular invasion, neural invasion, the number of positive SLNs, the number of negative SLNs, and the size of SLN metastasis (P

A novel method for removing arsenic (As) from intractable arsenopyrite (FeAsS)-bearing mine tailings was investigated that used a microwave technique. Although the tailings were poor microwave absorbers, absorption was indirectly assisted by adding various microwave-absorbing materials (MAMs), including MnO2 (oxidant), C (reductant), Fe3O4 and Fe2O3. The results revealed that the type of MAM and the microwave runtime significantly affected the efficiency of As-removal from the tailings and the magnetic effects of the reaction residuals. Compared with MnO2 and C, the best As-removal efficiencies of the tailings and the magnetic effects of the reaction residuals were obtained using Fe3O4 (90.12%, 24997.03 × 10−8 m3/kg, in 4 min) and Fe2O3 (92.10%, 19774.73 × 10−8 m3/kg, in 14 min). In addition, their As-removal efficiencies positively contributed to the magnetic effects, which increased with the microwave runtime. The obtained products were characterized by using a variety of analytical techniques (e.g., SEM, EDAX and XRD). Overall, Fe2O3 and Fe3O4 underwent similar As-removal pathways and magnetic products. Arsenic was mainly removed in the form of As (elemental form) and AsS in the oxygen-free atmosphere, and As2O3 was removed in the oxidizing atmosphere. Meanwhile, the arsenopyrite (FeAsS) and pyrite (FeS2) in the tailings, mixed with Fe2O3 or Fe3O4, were mainly converted into valuable pyrrhotite (Fe1−xS and FeS) and magnetite (Fe3O4) in the oxygen-free atmosphere. This study provides a feasible and environmentally friendly method for removing arsenic from tailings (or minerals), regardless of their microwave-absorbing properties.

Compared with permanent mold casting, the microstructure, mechanical properties, friction and wear of squeeze casting ZA27 alloy were studied. The results showed that squeeze casting can reduce or eliminate shrinkage porosity defect, refine or improve the microstructure and the shape and distribution of copper-rich ε phase which leads to the obvious improvement of the performance. In addition, with the increase of solution temperature, higher degree of super-saturation can enhance the tensile strength and hardness of ZA27 alloy. The better deformation coordination is an important factor to the enhancement of elongation. Remelting among grain boundaries leads to the deterioration of performance rapidly.

Background Ultrasound shear-wave elastography (SWE) may increase specificity of breast lesion assessment with ultrasound, but elasticity measurements may change with transducer orientation, defined as anisotropy. In this study, we aimed to observe the anisotropy of SWE of breast lesions, and its correlation with clinical and histopathological findings. Methods This retrospective study was approved by institutional review board. From June 2014 to June 2015, a total of 276 women (mean age, 48.75 ± 12.12 years) with 276 breast lesions (174 malignant, 102 benign) were enrolled for conventional ultrasound and SWE before surgical excision. Elasticity modulus in the longest diameter and orthogonal diameter were recorded, including maximum elasticity (Emax), mean elasticity (Emean), standard deviation (Esd) and ratio between mean elasticity of lesion and normal fatty tissue (Eratio). Anisotropy coefficients including anisotropic difference (AD) and anisotropy factors (AF) were calculated, and correlations with malignancy, tumor size, palpability, movability, lesion location and histopathology were analyzed. Results The average Emax, Emean, Esd and Eratio of the longest diameter were significantly higher than orthogonal diameter (P

Supplementary cementitious materials (SCM) are commonly added to improve the performance of concrete. However, the effects of SCM on the behaviour of cement paste/mortar/concrete depend on many factors and have so far remained elusive, making the mix design of high-performance concrete containing SCM rather difficult. This paper evaluates the effects of SCM, the fresh and hardened properties of mortar made with superfine cement and condensed silica fume added at different water/cementitious materials ratios. First, the packing densities of the solid particles in the mortar samples were measured directly by a new wet packing method. Then, based on the measured packing densities, a mix parameter called water film thickness (WFT) was quantitatively evaluated. The results showed that the WFT plays important roles in the fresh and hardened properties of mortar, as demonstrated by the good correlations established between the WFT and the rheology as well as the strength of the mortar samples tested.

A number of cement paste samples with condensed silica fume (CSF) contents ranging from 0% to 25% and different water contents were made and their respective strength, rheological properties, cohesiveness and packing density were measured. The results showed that whilst the addition of CSF would increase the strength of cement paste, there is an optimum CSF content beyond which further addition of CSF would cause reduction in strength. More importantly, the addition of CSF has great effects on the flowability, cohesiveness and packing density of cement paste, and under certain conditions can increase both the flowability and cohesiveness. In-depth analysis revealed that the various rheological properties are governed mainly by the water film thickness whereas the cohesiveness is dependent not just on the water film thickness but also on other factors.

Shuang Hao,1,2 Zhe-Bin Liu,1,2 Hong Ling,1,2 Jia-Jian Chen,1,2 Ju-Ping Shen,1,2 Wen-Tao Yang,2,3 Zhi-Min Shao1,2,4,5 1Department of Breast Surgery, Fudan University Shanghai Cancer Center, 2Department of Oncology, Shanghai Medical College, Fudan University, 3Department of Pathology, Fudan University Shanghai Cancer Center, 4Institute of Biomedical Science, Fudan University, 5Key Laboratory of Breast Cancer in Shanghai, Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China Abstract: Diagnostic patterns in breast cancer have greatly changed over the past few decades, and core needle biopsy (CNB) has become a reliable procedure for detecting breast cancer without invasive surgery. To estimate the changing diagnostic patterns of breast cancer in urban Shanghai, 11,947 women with breast lesions detected by preoperative needle biopsy between January 1995 and December 2012 were selected from the Shanghai Cancer Data base, which integrates information from approximately 50% of breast cancer patients in Shanghai. The CNB procedure uses an automated prone unit, biopsy gun, and 14-gauge needles under freehand or ultrasound guidance and was performed by experienced radiologists and surgeons specializing in needle biopsies. Diagnosis and classification for each patient were independently evaluated by pathologists.Over the indicated 8-year period, biopsy type consisted of 11,947 ultrasound-guided core needle biopsies (UCNBs), 2,015 ultrasound-guided vacuum-assisted biopsies (UVABs), and 654 stereotactic X-ray-guided vacuum-assisted biopsies (XVABs).For all the 11,947 women included in this study, image-guided needle biopsy was the initial diagnostic procedure. Approximately 81.0% of biopsied samples were histopathologically determined to be malignant lesions, 5.5% were determined to be high-risk lesions, and 13.5% were determined to be benign lesions. The number of patients choosing UCNB increased at the greatest rate, and UCNB has become a standard procedure for histodiagnosis because it is inexpensive, convenient, and accurate. The overall false-negative rate of CNB was 1.7%, and the specific false-negative rates for UCNB, UVAB, and XVAB, were 1.7%, 0%, and 0%, respectively. This study suggests that the use of preoperative needle biopsy as the initial breast cancer diagnostic procedure is acceptable in urban Shanghai. Preoperative needle biopsy is now a standard procedure in the Shanghai Cancer Center because it may reduce the number of surgeries needed totreat breast cancer. Keywords: breast carcinoma, core needle biopsy,ultrasound-guided core needle biopsies

Addition of supplementary cementitious materials (SCM) has been contradictorily reported to be beneficial or detrimental to the flowability of concrete and no general conclusion can be drawn up to now. In order to comprehensively disclose the effects of SCM on the flowability, an experimental study had been carried out to measure the flowability of a total of 100 cement paste samples with different condensed silica fume (CSF) and superfine cement (SFC) contents at a wide range of water/cementitious materials (W/CM) ratios. The results showed that the addition of CSF would decrease the flowability at a relatively high W/CM ratio but increase the flowability at a low W/CM ratio, while the addition of SFC could generally improve the flowability of cement paste. Joint addition of SFC and CSF would not exert any definite effect on flowability at a relatively high W/CM ratio but could improve the flowability at a low W/CM ratio. In-depth analysis showed that these results could be well explained by the theory of water film thickness.

Sentinel lymph node biopsy (SLNB) has been generally adopted as an alternative procedure to axillary lymph node dissection (ALND) for node staging. ALND remains the standard management of the axilla when a tumor-positive sentinel lymph node (SLN) is identified. However, further analysis has demonstrated that in 40–70% of cases with metastasis to the axillary lymph nodes, the SLN is the only positive node. Therefore, the traditional recommendation that ALND is always necessary for management of early-stage breast cancer patients with a positive SLN should be re-evaluated. Several nomograms and scoring systems have been developed to calculate the probability of non-SLN involvement on the basis of several clinicopathological variables. However, the actual value of such nomograms or scoring systems in daily clinical practice should be evaluated. This review focuses on the above topics and pushes forward the current heated debate on the management of early-stage breast cancer patients with a positive SLN.

Condensed silica fume (CSF) is often added into concrete mixes to enhance the properties of concrete. However, the effect of CSF on the heat evolution and temperature rise of concrete is not clearly known. Test results in the literature are insufficient and sometimes contradictory to enable any conclusion to be drawn regarding the role of CSF in heat generation behaviour of concrete. Moreover, since the chemical reactions of cement and CSF both involve water and hence cement and CSF are competing with each other in reacting with water, the water to binder (W/B) ratio may affect the temperature rise characteristics of concrete. This paper reports an experimental study of adiabatic temperature rise of CSF concrete conducted at The University of Hong Kong. Five concrete mixes without CSF and 10 concrete mixes with CSF dosages at 5% and 10% were tested with the recently developed semi-adiabatic curing test method. The adiabatic temperature rise was obtained by applying heat loss compensation to the test results. It was found that the addition of CSF could suppress the adiabatic temperature rise of concrete. At the same time, the strength of concrete could be enhanced. Based on the experimental results, prediction formula and design chart of adiabatic temperature rise of CSF concrete were developed.

Accurate intraoperative diagnosis of sentinel node metastasis enables the surgeon to make an immediate decision to proceed to axillary lymph node dissection (ALND), thereby avoiding the economic and psychological costs of a second operation. The present study aimed to evaluate the clinical value of touch imprint cytology (TIC) and investigate the potential factors associated with misdiagnosis. A total of 366 patients with Tis-T2 breast carcinoma were included after undergoing successful sentinel lymph node biopsy (SLNB). TIC was routinely performed intraoperatively, and the results were compared with definitive histological assessments of serial sections (SS) with hematoxylin and eosin (H&E) staining. A total of 992 SLNs from 366 patients were used in the study. Based on the final histological diagnosis, the sensitivity, specificity and overall accuracy of TIC was 76.6, 98.8 and 92.3%, respectively, on a per patient basis, and 79.9, 98.9 and 96.1%, respectively, on a per node basis. TIC was significantly more sensitive for macrometastasis than micrometastasis (80.0 vs. 28.6%, P

Owing to the less exothermic pozzolanic reaction of pulverized fuel ash (PFA) compared to cement hydration, the addition of PFA can reduce the heat generation of concrete during its hardening. However, as the water to binder (W/B) ratio would affect the proportions of cement and PFA that could react with water, the conventional practice of determining concrete temperature rise solely based on the cement and PFA contents may not yield accurate estimations. An experimental programme was launched to investigate the adiabatic temperature rise of PFA concrete mixes. Seven concrete mixes without PFA added and 14 concrete mixes with PFA dosages at 20% and 40% were tested with the recently developed semi-adiabatic curing test method. The adiabatic temperature rise was obtained by applying heat loss compensation to the test results. It was found that the incorporation of PFA could suppress the adiabatic temperature rise by 4°C to 14°C. The test results revealed the dependence of adiabatic temperature rise on both PFA dosage and W/B ratio, whose combined effects can be accurately addressed via the prediction formula and design chart developed herein.

The packing density of the powder in cement paste has great influence on the performance of the concrete. A higher packing density could at the same water/powder ratio increase the amount of excess water for lubricating the cement paste and thereby improve the flowability of the concrete. Alternatively, it would allow the water/powder ratio to be reduced to improve the strength of the concrete without compromising the flowability. Therefore, it is of great interest, especially for production of high-performance concrete, to maximize the packing density of the powder. This study aims to investigate the roles of superplasticizer and fillers in the packing density of the powder in cement paste. Packing density tests were carried out to determine the packing density of cement with various dosages of superplasticizer and different fillers (limestone fine, superfine cement and condensed silica fume) added using a newly developed wet packing method. The results showed that the addition of superplasticizer can significantly improve the packing density of cement while the addition of fillers can further improve the packing density of the powder.

Green roof systems are living vegetation integrated on top of roofs. They could enhance the built environment in a number of ways. Herein, different types of green roof and their structural arrangement and materials design are introduced. Various benefits offered by green roof to the urban habitat are discussed. Finally, examples of applications of green roofs are presented.

BACKGROUND:The aim of this study was to investigate the current surgical management strategy for bilateral breast cancer (BBC) patients and to assess the changes in this strategy in China. METHODS:This is a retrospective review of all patients with early-stage BBC who underwent surgical treatment at the Fudan University Shanghai Cancer Center between June 2007 and June 2014. RESULTS:A total of 15,337 patients with primary breast cancer were identified. Of these patients, 218 (1.5%) suffered from synchronous bilateral breast cancer (sBBC), and 296 (2.0%) suffered from metachronous bilateral breast cancer (mBBC). Patients with a lobular carcinoma component, those with estrogen receptor-positive cancer, and those with an accompanying sclerosing adenosis in the affected breast tended to develop BBC. The rates of bilateral mastectomy, breast conserving therapy, reconstruction, and combined surgeries were 86.2%, 6.4%, 3.7%, and 3.7%, respectively, for patients with sBBC and 81.1%, 4.4%, 3.0%, and 11.5%, respectively, for patients with mBBC. The interval between bilateral cancers, age at first diagnosis of breast cancer, histopathological type, and stage have significant impacts on the choice of surgery for patients with BBC. CONCLUSIONS:Bilateral mastectomy was the dominant surgical management for patients with BBC in China, despite the increased application of breast reconstruction surgery observed in recent years. Bilateral prosthetic breast reconstruction was the ideal choice for patients with sBBC. Chinese surgeons should take responsibility for patient education and inform their patients about their surgical options.

The aim of the study was to review the surgical trends in breast cancer treatment in China over the past 15 years and to explore the possible factors related to the choice of surgical modality. The medical records of 18,502 patients with unilateral early stage breast cancer who underwent surgery from January 1999 to December 2013 at our institute were retrospectively reviewed. The utilization of different surgical modalities and the associated clinicopathological factors were analyzed. Furthermore, the prognostic role of surgical modality was also evaluated. The median patient age was 50.0 years. According to the pTNM staging system, 12.5% of the patients were classified as stage 0; 30.2% as stage I; 40.0% as stage II; and 17.3% as stage III. In total, 9.3% of the patients could not be staged. Overall, 67.1% of the breast cancer cases were estrogen receptor (ER) positive. The pattern of breast cancer surgery has changed tremendously over the past 15 years (P

Background To validate the clinical value of the One-Step Nucleic Acid Amplification (OSNA) Breast Cancer System for the intraoperative detection of sentinel lymph node (SLN) metastases in early-stage breast cancer patients in a Chinese population, a prospective, multicenter trial, the China Breast Cancer Clinical Study Group (CBCSG)-001c trial, was conducted. The present study focused on the prospective comparison of the performance between OSNA and touch imprint cytology (TIC). Methods The retrieved SLNs were divided into sections. Alternate slices from the tissue blocks were subjected either to OSNA analysis or to postoperative histopathology evaluation through serial sectioning. TIC was performed on every sample surface of each tissue block and was used by the surgeon to determine whether to perform an immediate ALND. Results A total of 552 patients qualified for the analysis. The sensitivity, specificity, and overall accuracy of OSNA were 87.8%, 89.6%, and 88.4%, respectively, on a per-patient basis compared with those of TIC, which were 81.3%, 96.9%, and 92.0%, respectively. OSNA detected more micrometastasis-involved nodes than TIC (52.8% vs. 25.0%; p = 0.029) on a per-node basis. Tissue allocation bias (TAB) was the main cause of discordant results. The performance of TIC varied significantly among the institutes, while the performance of OSNA was steady. Conclusions Both OSNA and TIC can serve as qualified intraoperative assessments of SLNs. For institutes lacking the support of experienced cytopathologists, OSNA can be the first choice for the intraoperative assessment. In addition, OSNA can be applied as a complement to histopathology assessment. However, the results of the present study do not support the routine application of OSNA in the entire SLNs in place of pathology with serial sectioning.

We assessed the MSKCC nomogram performance in predicting SLN metastases in a Chinese breast cancer population. A new model (the SCH nomogram) was developed with clinically relevant variables and possible advantages. Data were collected from 1,545 patients who had a successful SLN biopsy between March 2005 and November 2011. We validated the MSKCC nomogram in the modeling and validation group. Clinical and pathologic features of SLN biopsy in modeling group of 1,000 patients were assessed with multivariable logistic regression to predict the presence of SLN metastasis in breast cancer. The SCH nomogram was created from the logistic regression model and subsequently applied to 545 consecutive SLN biopsies. By multivariate analysis, age, tumor size, tumor location, tumor type, and lymphovascular invasion were identified as independent predictors of SLN metastasis. The SCH nomogram was then developed using the five variables. The new model was accurate and discriminating (with an AUC of 0.7649 in the modeling group) compared to the MSKCC nomogram (with an AUC of 0.7105 in the modeling group). The area under the ROC curve for the SCH nomogram in the validation population is 0.7587. The actual probability trends for the various deciles were comparable to the predicted probabilities. The false-negative rates of the SCH nomogram were 1.67, 3.54, and 8.20 % for the predicted probability cut-off points of 5, 10, and 15 %, respectively. Compared with the MSKCC nomogram, the SCH nomogram has a better AUC with fewer variables and has lower false-negative rates for the low-probability subgroups. The SCH nomogram could serve as a more acceptable clinical tool in preoperative discussions with patients, especially very-low-risk patients. When applied to these patients, the SCH nomogram could be used to safely avoid a SLN procedure. The nomogram should be validated in various patient populations to demonstrate its reproducibility.

Accurate intraoperative diagnosis of sentinel lymph node (SLN) metastases enables the selection of patients for axillary lymph node dissections during the same operation, reducing the need for a second operation. The present study aimed to prospectively compare the GeneSearch(TM) Breast Lymph Node (BLN) Assay with touch imprint cytology (TIC) for intraoperative evaluation of SLNs.SLNs were sectioned in 1.5 - 3.0 mm pieces. TIC was performed on all pieces and the BLN Assay and postoperative histology evaluations were performed on different alternating node pieces. Overall performance of the BLN Assay was compared with that of TIC relative to the postoperative histology results.A total of 90 patients enrolled in the study. Complete intraoperative data for both the BLN Assay and TIC were collected in 86 patients. The sensitivity, specificity, and overall accuracy of the BLN Assay were 82%, 97%, and 92%, respectively on a per patient basis compared with those of TIC which were 67%, 100%, and 90%.Performance of the BLN Assay was superior to that of TIC and the additional application of TIC did not help improve the total sensitivity and accuracy of the intraoperative assessment. The existence of ectopic breast tissue might be a possible cause of false positive for the BLN assay. In addition, the BLN Assay complements histopathology assessment and can minimize sampling error without increasing pathologists' workload.

to evaluate the application of GeneSearch(TM) breast lymph node assay in intraoperative detection of metastases in sentinel lymph node (SLN) from breast cancer patients.a total of 225 SLN from 88 patients was prospectively studied. Each SLN was cut into 2 mm slabs which were examined by intraoperative imprint cytology (IIC) first, followed by GeneSearch assay and post-operative serial sectioning. GeneSearch used real-time fluorescence quantitative RT-PCR technology to detect the expression of CK19 and mammaglobin in SLN. The results of GeneSearch assay were correlated with those of IIC and post-operative serial sectioning.amongst the 88 cases studied, 225 SLNs were found, and obvious metastatic carcinoma cells were identified in 27 SLNs and micrometastasis in 9 SLNs. One hundred and eight-nine SLNs were considered as "negative" (with "isolated tumor cells" present in 5 SLNs). The turn-around time of intraoperative GeneSearch assay ranged from 35 to 45 minutes (mean = 40 minutes). The concordance rate between GeneSearch assay and post-operative serial sectioning was 95.6% (215/225), with a sensitivity of 86.1% (31/36), compared with 94.7% (213/225) and 72.2% (26/36) respectively for IIC. The size of metastatic foci correlated with the Ct value of CK19 and mammaglobin (P0.01).GeneSearch assay for intraoperative detection of metastase in SLN has a satisfactory performance and demonstrates a relatively higher sensitivity than IIC. The potential clinical application still requires further evaluation of larger number of cases.