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The cavity-based X-ray free-electron laser (XFEL) has promise in producing fully coherent pulses with a bandwidth of a few meV and very stable intensity, whereas the currently existing self-amplified spontaneous emission (SASE) XFEL is capable of generating ultra-short pulses with chaotic spectra. In general, a cavity-based XFEL can provide a spectral brightness three orders of magnitude higher than that of the SASE mode, thereby opening a new door for cutting-edge scientific research. With the development of superconducting MHz repetition-rate XFEL facilities such as FLASH, European-XFEL, LCLS-II, and SHINE, practical cavity-based XFEL operations are becoming increasingly achievable. In this study, megahertz cavity enhanced X-ray generation (MING) is proposed based on China’s first hard XFEL facility - SHINE, which we refer to as MING@SHINE.

To summarize the experience of 40 patients with pancreatic adenocarcinoma treated with irreversible electroporation ablation (IRE), their experiences with surgical nurses, and to explore the best nursing methods before and during IRE ablation. Preoperative visits were conducted to assess the condition of patients, and psychological counseling was subsequently given to them. All material and medication required for the operation were prepared in advance, and placed in appropriate locations. All 40 patients were treated successfully. The mean time of IRE ablation was 63.33±12.26 (range, 37–87) minutes, and mean blood loss was 2.09±0.49 (range: 1.0–2.8) mL. There were no ablation-related deaths. Skillful mastery of nanoknife usage and troubleshooting methods, intensive observation of patients’ vital signs during ablation, and active cooperation with surgeons can ensure successful ablation and can reduce the influence of improper nursing during ablation on patients’ prognosis.

Purpose Diseases relapse and severe infection caused by delayed immune reconstitution are still challenges in the haplo-identical hematopoietic stem cell transplantation (haplo-HSCT). Non-myeloablative transplant regimens also only alleviated these complications and did not solve the above problems. Among them, the thymus damage caused by preconditioning including irradiation and chemotherapy and graft-versus-host disease (GVHD) is the primary issue. Accelerating the recovery of thymus-derived T cells after transplantation is a key to solving above problem. Methods Therefore, we established a cell culture system using Notch ligand Delta4 and IL-7 that could induce and amplify hematopoietic stem cells differentiation and proliferation into precursor T (preT) cells in vitro. Non-myeloablative HSCT protocol was modified by using induced preT and G-CSF mobilized donor splenic mononuclear cells (MNC) co-infusion. Thymic GVHD, thymic repair, thymus-derived T cell development were compared in thymus-irradiated mice treated with MNC+preT and only MNC by polychromatic immunofluorescence tracking and T cell receptor Vβ detection. Results The data showed that pre T cells highly expressed CC9 and RANKL markers restored thymic architecture, weakened GVHD effects, enhanced immuno-tolerance and accelerated immune reconstitution by activating the RANK/RANKL pathway.Conclusion The modified non-myeloablative regimen containing preT cells will be more conducive to the widespread use of haplo-HSCT in clinical work.

Objective The study aimed to compare effectiveness and safety of thermal ablation and hepatic resection in patients with liver metastases of gastrointestinal stromal tumors (GISTs). Method A total of 55 patients (27 in the ablation group and 28 in the surgery group) with liver metastases were included. Overall survival (OS) and progression-free survival (PFS) were assessed with Kaplan–Meier’s survival estimate curves. Univariate and multivariate regression analyses were carried out to identify potential prognostic factors. Results The median OS was 102.0 months in the ablation group and 117.0 months in the surgery group (p = .875). The 1-, 3- and 5-year OS rates were 100%, 88.9% and 74.1% in the ablation group and 92.8%, 82.1% and 78.6% in the surgery group, respectively. The 1-, 3- and 5-year PFS rates were 48.1%, 25.9% and 18.5% in the ablation group and 67.8%, 64.3% and 64.3% in the surgery group, respectively. Multivariate analysis showed that preoperative tyrosine kinase inhibitor (TKI) treatment (progressive disease, PD) (HR, 13.985; 95% CI, 1.791–109.187; p = .012) was the only significant independent prognostic factor for OS. Tumor number (HR, 1.318; 95% CI, 1.021–1.702; p = .034) was identified as an independent predictor for PFS in multivariate analysis. There were fewer postoperative complications (18.5% vs. 78.6%, p = .001) and shorter lengths of hospital stay (8.0 vs. 16.5 days, p = .001) in the ablation group. Conclusion Compared with resection, thermal ablation offered comparable OS for liver metastases of GISTs. Furthermore, thermal ablation had the advantages of fewer complications and shorter lengths of hospital stay.

Background: Delayed hematopoietic recovery was one of the factors that limited the clinic application of umbilical cord blood (UCB) transplantation. Two different methods of overcoming the limitation were evaluated by this systematic review and meta-analysis. One strategy was to expand UCB unit ex vivo for increasing cell dose and another strategy was to incubate UCB unit with small molecules in vitro for enhancing bone marrow (BM) homing ability. Methods: Relevant literatures were collected from 2000 to 2020 by searching the databases of PubMed, Medline, and EMBASE. A total of 15 studies that met the inclusion criteria were included in the meta-analysis. Results: Similar clinical effects including neutrophil recovery (P=0.308), platelet recovery (P=0.4754), and 100-day survival (P=0.4216) between two methods were observed. Faster neutrophil recovery was associated with higher infused total nucleated cells (TNCs) (R2=0.4526 P2=0.9777 P=0.095) in patients of expansion group and incubation group, respectively. Conclusion: Although the treatment outcomes by using expanded stem cells were getting better all these years with fast development of cell culture techniques according to our cumulative meta-analysis. It seems the application of incubation procedure was safer and more convenient than expansion regarding to their similar clinic effects. This study was registered at RROSPERO (Registration no. CRD42020149750).

Background Post-transplant lymphoproliferative disorders (PTLDs) represent a spectrum of heterogenetic lymphoid proliferations. PTLD is a serious complication that affects the long-term survival of kidney transplant patients. Imaging examination is an important method for detecting and diagnosing PTLD. Contrast-enhanced ultrasonography (CEUS) and CEUS-guided biopsy are important modalities for tumor detection and diagnosis. In this case, we describe a 69 years old man in whom a native kidney PTLD was confirmed by CEUS. Case presentation A 69-year-old male patient who had a kidney transplant 1 year earlier presented with 3 months of progressive myasthenia of both lower limbs associated with amyotrophy and weight loss. Although positron emission tomography/computed tomography (PET-CT) showed a high metabolic lesion in the untransplanted kidney, abdominal contrast enhanced computed tomography cannot detect the lesion in the atrophic left kidney. The above examinations showed that the transplanted kidney was normal. CEUS can detect a homogeneously enhanced lesion in the same location as PET-CT. Subsequently, a biopsy was performed under CEUS guidance, and the final pathological diagnosis was diffuse large B-cell lymphoma. The patient then received the R-CHOP treatment. Unfortunately, pulmonary thromboembolism occurred 2 weeks later, and the patient’s condition was not alleviated through active treatment. Finally, the patient’s family gave up treatment, and the patient was discharged. Conclusion The case suggested that CEUS was a valuable imaging method for patient with renal transplantation to detect and diagnose of PTLD.

Background In this study, we investigated the association of time-varying serum albumin levels with mortality over a 5-year period in one cohort of patients undergoing long-term peritoneal dialysis (PD) therapy. Methods The participants in this study enrolled 302 patients who underwent long-term PD at a single PD center in Taiwan. We reviewed medical records from 2011 to 2015 retrospectively. Time-averaged albumin level and serum albumin reach rate (defined as the percentage of serum albumin measurements that reached ≥3.5 g/dL) were applied as the predictor variables in the first 2 years (2011–2012). All-cause mortality was used as the outcome variable in the subsequent 3 years (2013–2015). Hazard function of all-cause mortality in the study participants was examined by using Cox proportional hazard regression models . Results Patients with different albumin reach rates (75–

Background/Aims: Studies on the long-term clinical benefits of hemodiafiltration (HDF) and high-flux hemodialysis (HFHD) are very limited. This study aimed to investigate the hospitalization rate and aortic arch calcification (AAC) of these two dialysis modalities over 6 years. Methods: Participants who received regular HDF and HFHD in one hospital-facilitated hemodialysis center were prospectively enrolled after matching for age, sex, and diabetes between January 2009 and December 2014. Medical records were reviewed retrospectively on demographics, laboratory variables, calcified scores in aortic arch measured by chest radiography, and rates of hospital admission. Cox proportional hazard regression and linear regression were used to obtain the outcome results. Results: The HDF and HFHD groups consisted of 108 and 102 participants, respectively. Levels of laboratory variables including small soluble solutes and Kt/V were not statistically different over the 6-year period between the HDF and HFHD groups. Calcified scores of the aortic arch increased over 6 years in both groups. The changes in the mean calcified scores were significant when compared between the two groups (0.44–1.82 in HFHD, 0.79–1.8 in HDF, respectively, p = 0.008). Hospitalization rates were 735 per 1,000 patients in the HDF group and 852 per 1,000 patients in the HFHD group, respectively. No significant difference was observed in frequency and days of hospitalization between HDF and HFHD. Conclusion: Hospitalization rates and AAC were observed to be equal for HDF and HFHD.

Patients on peritoneal dialysis (PD) encounter peritoneal functional and structural alterations. It is still unknown whether levels of plasminogen activator inhibitor type 1 (PAI-1), matrix metalloproteinases- (MMP-) 2, and vascular endothelial growth factor (VEGF) exhibit dynamic changes in peritoneal effluents. The aim of the present study was to investigate the longitudinal changes in these biomarkers in PD patients and their association with peritoneal small-solute transfer rate (PSTR). This prospective, single-center cohort study included 70 new PD patients. The presence of PAI-1, MMP-2, and VEGF in peritoneal effluents was measured regularly after PD initiation. The association between those biomarkers and 4-hour effluent:plasma creatinine ratio (PSTR) was analyzed. Longitudinal follow-up showed a tendency for PAI-1 (p< 0.001) and VEGF (p= 0.04) to increase with the duration of PD. Both PSTR at baseline and PSTR at 2 years significantly associated with PAI-1, MMP-2, and VEGF levels at baseline. PSTR at 2 years also associated with the MMP-2 level at 6 months and PAI-1 level at baseline. The present study illustrated a positive association of PSTR with selected biomarkers in peritoneal effluents observed over a 2-year period.

The aim of this study was to explore the principle of moblile echogenicities in epididymis in patients with a history of postvasectomy or infertility, which were reported as the characteristic sonographic sign of filarial infection. We reported a 38-year-old man presented with a 3-year history of infertility after marriage. Ultrasound imaging revealed an enlarged body in the inner left epididymis along with innumerable punctate mobile echogenicities, which showed random to-and-fro movements in the left epididymis. This had previously been recognized as the sonographic filarial dance sign of live filarial worms or microfilaria. The patient subsequently underwent needle aspiration of the left epididymis. Histopathological examination confirmed that the mobile echogenicities were a large number of macrophages with phagocytized sperm or clumps of agglutinated sperm. Our report includes a video clip that will help familiarize readers with this phenomenon. Our case highlighted that moblile echogenicities should be an important sign for epididymal obstruction to initiate corresponding treatment.

A 23-year-old woman presented with a half-year history of right forearm sensory and motor dysfunction. Ultrasound imaging revealed definite thickening of the right ulnar nerve trunk and inner epineurium, along with heterogeneous hypoechogenicity and unclear nerve fiber bundle. Color Doppler exhibited a rich blood supply, which was clearly different from the normal ulnar nerve presentation with a scarce blood supply. The patient subsequently underwent needle aspiration of the right ulnar nerve, and histopathological examination confirmed that granulomatous nodules had formed with a large number of infiltrating lymphocytes and a plurality of epithelioid cells in the fibrous connective tissues, with visible atypical foam cells and proliferous vascularization, consistent with leprosy. Our report will familiarize readers with the characteristic sonographic features of the ulnar nerve in leprosy, particularly because of the decreasing incidence of leprosy in recent years.