原发性肝癌合并脾功能亢进低剂量姑息性放射治疗的临床研究

目的:评价原发性肝癌合并脾功能亢进低剂量姑息性放射治疗的疗效及其临床意义。方法:对我院符合诊断标准的28例原发性肝癌伴脾功能亢进患者三维适形放射治疗,分割剂量2 Gy/次,5次/周,总剂量10~25 Gy,治疗4周中监测白细胞,红细胞,血小板,以及门静脉主干,脾静脉和脾指数等各项指标。结果:28例患者在治疗刚开始1周白细胞、血小板有轻度下降,随后白细胞及血小板开始恢复。放疗前后白细胞、血小板数比较,差异有统计学意义(p>0.05)。治疗后门静脉主干,脾静脉,脾指数均有不同程度缩小,差异有统计学意义(p <0.05)。结论:原发性肝癌导致的脾功能亢进予低剂量姑息性放射治疗可以使脾脏体积和血供减小,白细胞、血小板上升,有效的缓解患者症状。此方法是一种安全、有效的治疗方式,值得临床推广应用。

Idiopathic mesenteric phlebosclerosis associated with long-term use of medical liquor:Two case reports and literature review

A 62-year-old woman was admitted to our hospital in2011 because of recurrent abdominal pain,nausea and constipation for six months.Computed tomography enterography(CTE)showed tortuous thread-like calcifications in the ileocolic vein and right colic vein,while colonoscopy revealed purple-blue mucosa extending from the cecum to the splenic flexure.Based on the results of these tests,the patient was diagnosed with idiopathic mesenteric phlebosclerosis(IMP).She had a history of Chinese medical liquor intake for one and a half years and her symptoms subsided after conservative treatment.In 2013,a 63-year-old male patient who presented with recurrent lower right abdominal pain,bloating,melena and diarrhea for fifteen months was admitted to our institution.Colonoscopy and CTE led to the diagnosis of IMP.He also used Chinese medical liquor for approximately 12 years.The patient underwent total colectomy and the postoperative course was uneventful.We searched for previously published reports on similar cases and analyzed the clinical data of 50 cases identified in PubMed.As some of these patients admitted use of Chinese medicines,we hypothesize that Chinese medicines may play a role in the pathogenesis of IMP.

Prognostic performance of interleukin-10 in patients with chest pain and mild to moderate coronary artery lesions an 8-year follow-up study

Background Interleukin （IL）-10, IL-6 and their ratio （IL-6/IL-10） play an important role in the risk of developing coronary artery disease, and may correlate with its outcomes. Few clinical trials have investigated the prognostic impact of these factors on long-term car- diovascular events in patients presented with chest pain. Methods A prospective study was performed on 566 patients admitted with chest pain and identified mild to moderate coronary artery lesions. 1L-10, IL-6 and IL-6/IL-10 were measured. Results A total of 511 patients com- pleted the follow-up. The median follow-up time was 74 months. Kaplan-Meier analysis demonstrated a clear increase of the incidence of major adverse cardiac events during the follow-up period in patients with below-median levels of IL-10 （P = 0.006） and above-median levels of IL-6/IL-10 （P = 0.012）. Multivariate Cox proportional hazards analysis indicated the IL-10 levels to be strong independent predictors after adjustment for underlying confounders. Conclusions Elevated IL-10 levels are associated with a more favorable long-term prognosis in patients with chest pain and mild to moderate coronary artery lesions. IL-10 could be used for early risk assessment of long-term prognosis.

Development of an improved CBR model for predicting steel temperature in ladle furnace refining

In the prediction of the end-point molten steel temperature of the ladle furnace, the influence of some factors is nonlinear. The prediction accuracy will be affected by directly inputting these nonlinear factors into the data-driven model. To solve this problem, an improved case-based reasoning model based on heat transfer calculation(CBR-HTC) was established through the nonlinear processing of these factors with software Ansys. The results showed that the CBR-HTC model improves the prediction accuracy of end-point molten steel temperature by5.33% and 7.00% compared with the original CBR model and 6.66% and 5.33% compared with the back propagation neural network(BPNN)model in the ranges of [-3, 3] and [-7, 7], respectively. It was found that the mean absolute error(MAE) and root-mean-square error(RMSE)values of the CBR-HTC model are also lower. It was verified that the prediction accuracy of the data-driven model can be improved by combining the mechanism model with the data-driven model.

Hexokinase II promotes the Warburg effect by phosphorylating alpha subunit of pyruvate dehydrogenase

Objective: Tumor cells rely heavily on glycolysis regardless of oxygen tension, a phenomenon called the Warburg effect. Hexokinase II(HKII) catalyzes the first irreversible step of glycolysis and is often overexpressed in tumor cells. Mitochondrial HKII couples glycolysis and oxidative phosphorylation while maintaining mitochondrial membrane integrity. In this study, we investigated the role of HKII in promoting the Warburg effect in cancer cells.Methods: HKII-mediated phosphorylation of the alpha subunit of pyruvate dehydrogenase(PDHA1) was tested in HEK293 T cells and clear cell renal cell carcinoma(cc RCC) specimens using gene knockdown, western blotting,immunohistochemistry, and immunofluorescence.Results: It was determined that HKII could not only transform glucose into glucose-6-phosphate, but also transfer the phosphate group of ATP onto PDHA1. In addition, it was found that HKII increased the phosphorylation of Ser293 on PDHA1, decreasing pyruvate dehydrogenase(PDH) complex activity and thus rerouting the metabolic pathway and promoting the Warburg effect. The overexpression of HKII correlated with the phosphorylation of PDHA1 and disease progression in cc RCC.Conclusions: The data presented here suggest that HKII is an important biomarker in the evaluation and treatment of cancer.

Long-term outcomes of staged recanalization for concurrent chronic total occlusion in patients with ST-segment elevation myocardial infarction after primary percutaneous coronary intervention

Background In patients with acute ST-segment elevation myocardial infarction(STEMI)who undergo primary percutaneous coronary intervention(PCI),approximately 10%are concomitant with a chronic total occlusion(CTO)in a non-culprit vessel.However,the impact of staged CTO recanalization on prognosis in this cohort remains disputable.This study aimed to compare the long-term outcomes of staged CTO recanalization versus medical therapy in patients with STEMI after primary PCI.Methods Between January 2005 and December 2016,a total of 287 patients were treated with staged CTO-PCI(n=91)or medical therapy(n=196)after primary PCI in our center.The primary endpoint was major adverse cardiovascular and cerebrovascular event(MACCE),defined as a composite of all-cause death,nonfatal myocardial infarction(MI),stroke or unplanned revascularization.After propensity-score matching,77 pairs of well-balanced patients were identified.Results The mean follow-up period was 6.06 years.Overall,the incidence of the primary endpoint of MACCE was significantly lower in staged CTO-PCI group than that in medical therapy group in both overall population(22.0%vs.46.9%;hazard ratio(HR)=0.48,95%CI:0.29-0.77)and propensity-matched cohorts(22.1%vs.42.9%;HR:0.48,95%CI:0.27-0.86).In addition,staged CTO-PCI was also associated with reduced risk of the composite of cardiac death,nonfatal MI or stroke compared with medical therapy in both overall population(9.9%vs.26.5%;hazard ratio(HR)=0.39,95%CI:0.19-0.79)and propensity-matched cohorts(9.1%vs.22.1%;HR:0.40,95%CI:0.16-0.96).After correction of the possible confounders,staged CTO-PCI was independently associated with reduced risks of MACCE(adjusted HR:0.46,95%CI:0.28-0.75),the composite of cardiac death,nonfatal MI or stroke(adjusted HR:0.45,95%CI:0.22-0.94)and all-cause mortality(adjusted HR:0.32,95%CI:0.13-0.83).Moreover,the results of sensitivity analysis were almost concordant with the overall analysis.Conclusions In patients with STEMI and a concurrent CTO who undergo primary PCI,successful staged recanalization of CTO in the non-culprit vessels is associated with better clinical outcomes during long-term follow-up.

Diagnosing anomalous characteristics of atmospheric water cycle structure during seasonal-scale drought events:A case study in middle and lower reaches of Yangtze River

Anomalous characteristics of the atmospheric water cycle structure are highly significant to the mechanisms of seasonal-scale meteorological droughts.They also play an important role in the identification of indicative predictors of droughts.To better understand the causes of seasonal meteorological droughts in the middle and lower reaches of the Yangtze River(MLRYR),characteristics of the atmospheric water cycle structure at different drought stages were determined using standardized anomalies.The results showed that the total column water vapor(TCWV)was anomalously low during drought occurrence periods.In contrast,there were no anomalous signals at the drought persistence and recovery stages in the MLRYR.Moreover,there was no significant temporal correlation between the TCWV anomaly and seasonal-scale drought index(the 3-month standardized precipitation index(SPI_(3))).During drought events,water vapor that mainly originated from the Bay of Bengal was transported southwest of the MLRYR.Meanwhile,the anomalous signal of water vapor transport was negative at the drought appearance stage.At the drought persistence stage,the negative anomalous signal was the most significant.Water vapor flux divergence in the MLRYR showed significant positive anomalous signals during drought events,and the signal intensity shifted from an increasing to a decreasing trend at different drought stages.In addition,a significant positive correlation existed between the anomaly of water vapor flux divergence and regional SPI_(3).Overall,water vapor flux divergence is more predictive of droughts in the MLRYR.

Long term outcomes of drug-eluting stent versus coronary artery bypass grafting for left main coronary artery disease： a meta-analysis

Background It is still controversial whether percutaneous coronary intervention with drug-eluting stent （DES） is safe and effective compared to coronary artery bypass graft surgery （CABG） for unprotected left main coronary artery （ULMCA） disease at long-term follow up （≥3 years）. Methods Eligible studies were selected by searching PubMed, EMBASE, and Cochrane Library up to December 6, 2016. The primary endpoint was a composite of death, myocardial infarction （MI） or stroke during the longest follow-up. Death, cardiac death, MI, stroke and repeat revascularization were the secondary outcomes. Results Four randomized controlled trials and twelve adjusted observational studies involving 14,130 patients were included. DES was comparable to CABG regarding the occurrence of the primary endpoint （FIR = 0.94, 95% CI： 0.86-1.03）. Besides, DES was significantly associated with higher incidence of MI （HR = 1.56, 95% CI： 1.09-2.22） and repeat revascularization （HR = 3.09, 95% CI： 2.33-4.10） compared with CABG, while no difference was found between the two strategies regard as the rate of death, cardiac death and stroke. Furthermore, DES can reduce the risk of the composite endpoint of death, MI or stroke （HR = 0.80, 95% CI： 0.67-0.95） for ULMCA lesions with SYNTAX score ≤32. Conclusions Although with higher risk of repeat revascularization, PCI with DES appears to be as safe as CABG for ULMCA disease at long-term follow up. In addition, treatment with DES could be an alternative interventional strategy to CABG for ULMCA lesions with low to intermediate anatomic complexity.

Application of a hybrid multiscalar indicator in drought identification in Beijing and Guangzhou,China

The Palmer drought severity index(PDSI) is physically based with multivariate concepts, but requires complicated calibration and cannot easily be used for multiscale comparison. Standardized drought indices(SDIs), such as the standardized precipitation index(SPI) and standardized precipitation evapotranspiration index(SPEI), are multiscalar and convenient for spatiotemporal comparison, but they are still challenged by their lack of physical basis. In this study, a hybrid multiscalar indicator, the standardized Palmer drought index(SPDI), was used to examine drought properties of two meteorological stations(the Beijing and Guangzhou stations) in China, which have completely different drought climatologies. The results of our case study show that the SPDI is correlated with the well-established drought indices(SPI, SPEI, and PDSI) and presents generally consistent drought/wetness conditions against multiple indicators and literature records. Relative to the PDSI, the SPDI demonstrates invariable statistical characteristics and better comparable drought/wetness frequencies over time and space. Moreover,characteristics of major drought events(drought class, and onset and end times) indicated by the SPDI are generally comparable to those detected by the PDSI. As a physically-based standardized multiscalar drought indicator, the SPDI can be regarded as an effective development of the Palmer drought indices, providing additional choices and tools for practical drought monitoring and assessment.

2DGE-coomassie brilliant blue staining used to differentiate pasteurized milk from reconstituted milk

Differentiating pasteurized milk and reconsti-tuted milk by scientific approach was necessary to defend consumer from economic fraud of wrong labeling. In this paper 2DGE (2 Dimen-sional Gel Electrophoresis)-coomassie brilliant blue staining method was employed and sig-nificant color intensity changing was observed among raw milk, pasteurized milk, UHT milk and reconstituted milk. For example, the intensity of 10 protein spots including casein and lac-toglobulin reduced more than two folds from pasteurized milk to reconstituted milk. However, DIGE (Differential Gel Electrophoresis) assay showed that the majority protein remained simi-lar level from pasteurized milk to reconstituted milk. Therefore the color fading of coomassie brilliant blue stained 2D gels may be due to other biochemical reaction, such as Maillard reaction, instead of protein degradation. Stability of 2DGE pattern was confirmed by running six gels of the same sample in parallel and software analysis showed that all proteins were at similar level. Two commercialized pasteurized milk samples and one reconstituted milk sample were tested by 2DGE-coomassie blue staining method and re-constituted milk could be easily identified.

Prediction of risk of cardiovascular events in patients with mild to moderate coronary artery lesions using naive Bayesian networks

Background This prospective study integrated multiple clinical indexes and inflammatory markers associated with coronary atherosclerotic vulnerable plaque to establish a risk prediction model that can evaluate a patient with certain risk factors for the likelihood of the occurrence of a coronary heart disease event within one year. Methods This study enrolled in 2686 patients with mild to moderate coronary artery lesions. Eighty-five indexes were recorded, included baseline clinical data, laboratory studies, and procedural characteristics. During the 1-year follow-up, 233 events occurred, five patients died, four patients suffered a nonfatal myocardial infarction, four patients underwent revascularization, and 220 patients were readmitted for angina pectoris. The Risk Estimation Model and the Simplified Model were conducted using Bayesian networks and compared with the Single Factor Models. Results The area under the curve was 0.88 for the Bayesian Model and 0.85 for the Simplified Model, while the Single Factor Model had a maximum area under the curve of 0.65. Conclusion The new models can be used to assess the short-term risk of individual coronary heart disease events and may assist in guiding preventive care.

Growth differentiation factor-15 is a prognostic marker in patients with intermediate coronary artery disease

Background Growth differentiation factor-15(GDF-15)is involved in multiple processes that are associated with coronary artery disease(CAD).However,little is known about the association between GDF-15 and the future ischemic events in patients with intermediate CAD.This study was conducted to investigate whether plasma GDF-15 constituted risk biomarkers for future cardiovascular events in patients with intermediate CAD.Methods A prospective study was performed based on 541 patients with intermediate CAD(20%–70%).GDF-15 of each patient was determined in a blinded manner.The primary endpoint was major adverse cardiac event(MACE),which was defined as a composite of all-cause death,nonfatal myocardial infarction,revascularization and readmission due to angina pectoris.Results After a median follow-up of 64 months,504 patients(93.2%)completed the follow-up.Overall,the combined endpoint of MACE appeared in 134 patients(26.6%)in the overall population:26 patients died,11 patients suffered a nonfatal myocardial infarction,51 patients underwent revascularization,and 46 patients were readmitted for angina pectoris.The plasma levels of GDF-15(median:1172.02 vs.965.25 pg/m L,P=0.014)were higher in patients with ischemic events than those without events.After adjusting for traditional risk factors,higher GDF-15 levels were significantly associated with higher incidence of the composite endpoint of MACE(HR=1.244,95%CI:1.048–1.478,Quartile 4 vs.Quartile 1,P=0.013).Conclusions The higher level of GDF-15 was an independent predictor of long-term adverse cardiovascular events in patients with intermediate CAD.

A study on the influence mechanism of PBL teaching model on non-English major students＇ critical thinking ability

PBL teaching mode is a kind of emphasis on students＇ independent inquiry based learning approach, which is concerned withthe problem of inquiry and solution process, focusing on the cultivation of students＇ ability. The teaching mode is a new teaching mode basedon the problem and the students as the main body. The open and distance education students of economics as the research object, using the PBLmode of teaching, the results show that the effect of the teaching mode of PBL is obviously better than the traditional teaching mode is helpfulto improve the students＇ ability of autonomous learning, inquiry learning, acquisition, processing and use of statistical information, and theanalysis of the problem, the comprehensive ability to solve problems etc.. The PBL model of critical thinking training includes students＇participation in the setting of goals and problems, group discussion cognitive activities and the reflection and evaluation of teachers and students.

Hierarchically designed MoWSe_(2)/WO_(3)/C anode for fast and efficient Na+storage

Exploring anode materials with high energy and power density is one of the critical milestones in developing sodium-ion batteries/capacitors(SIBs/SICs).Here,the Mo and W-based bimetallic organic framework(Mo-W-MOF)with core-shell structure is first formed by a facile strategy,followed by a selenization and carbonization strategy to finally prepare multileveled Mo WSe_(2)/WO_(3)/C anode materials with core-shell petal like curled nanosheet structure.Between the petal(MoSe_(2))-core(WO_(3))structure,the formation of WSe_(2)flakes by partial selenization on the surface of WO_(3)serves as a heterogeneous connection between MoSe_(2)and WO_(3).The enlarged layer distance(0.677 nm)between MoSe_(2)and WSe_(2)can facilitate the rapid transfer of Na+and electrons.The density functional theory(DFT)calculations verify that the Mo WSe_(2)/WO_(3)/C heterostructure performs excellent metallic properties.Ex-situ X-ray diffraction(XRD),X-ray photoelectron spectroscopy(XPS),and transmission electron microscopy(TEM)confirm the activation process from the initial insertion reaction to the later conversion reaction.Resultantly,when employed as the anode of SIBs,a remarkable capacity of 384.3 mA h g-1after 950 cycles at 10 A g^(-1)is performed.Furthermore,the SICs assembled with commercial activated carbon(AC)as the cathode exhibits a remarkable energy density of 81.86 W h kg^(-1)(at 190 W kg^(-1))and 72.83 W h kg^(-1)(at 3800 W kg^(-1)).The unique structural design and the reaction investigation of the electrode process can provide a reference for the development of transition metal chalcogenides anodes.

Measurement and Characterization of Microwave Interaction between Integrated Distributed Feedback Laser Diode and Electro-Absorption Modulator

Integrated electro-absorption-modulated distributed feedback laser diodes(EMLs)are attracting much interest in optical communications for the advantages of a compact structure,low power consumption,and high-speed modulation.In integrated EML,the microwave interaction between the distributed feedback laser diode(DFB-LD)and the electro-absorption modulator(EAM)has a nonnegligible influence on the modulation performance,especially at the high-frequency region.In this paper,integrated EML was investigated as a three-port network with two electrical inputs and a single optical output,where the scattering matrix of the integrated device was theoretically deduced and experimentally measured.Based on the theoretical model and the measured data,the microwave equivalent circuit model of the integrated device was established,from which the microwave interaction between DFB-LD and EAM was successfully extracted.The results reveal that the microwave interaction within integrated EML contains both the electrical isolation and optical coupling.The electrical isolation is bidirectional while the optical coupling is directional,which aggravates the microwave interaction in the direction from DFB-LD to EAM.

A comparison of carotid atherosclerosis in symptomatic patients between 2002-2005 and 2012-2015 cohorts using multi-contrast magnetic resonance vessel wall imaging

OBJECTIVE To compare the morphological and compositional characteristics of carotid plaques in two cohorts(2002−2005 and 2012−2015)of Chinese patients using magnetic resonance vessel wall imaging.METHODS Symptomatic patients with carotid atherosclerotic plaques who underwent carotid vessel wall magnetic resonance imaging between 2002−2005 and 2012−2015 were retrospectively recruited.Plaque morphology[including mean wall area,wall thickness,and maximum normalized wall index(NWI)]and composition[including calcification,intraplaque hemorrhage,and lipid-rich necrotic core(LRNC)]in symptomatic carotid arteries were evaluated and compared between patients in these two time periods.RESULTS A total of 258 patients,including 129 patients in the 2002−2005 cohort and 129 patients in the 2012−2015 cohort,were recruited.Statin use(49.6%vs.32.6%,P=0.004)and hypertension(76.0%vs.62.8%,P=0.015)were significantly more common in the 2012-2015 cohort than in the 2002−2005 cohort.Patients in the 2012−2015 cohort also exhibited significantly low plaque burden parameters(all P<0.05),as well as a lower prevalence(68.2%vs.89.9%,P<0.001)and volume percentages of LRNC(11.2%±14.2%vs.25.7%±17.7%,P<0.001).These differences remained significant after adjustment for clinical factors.The differences in the volume percentages of LRNC also remained significant after an additional adjustment for maximum NWI(P<0.001).CONCLUSIONS Patients in the 2012−2015 cohort had a lower plaque burden and volume percentages of LRNC in symptomatic carotid arteries than those in the 2002−2005 cohort.These findings indicate that carotid plaques in the recent cohort had a lower severity and vulnerability.

Coordinated Control of Multi-FACTS to Enhance the Dynamic Stability of the Power System

This article introduces a FACTS coordinated control strategy with impedance/admittance measurement feedback. Then the effectiveness of this method is proved in mathematics with damp torque method. The control strategy effect is verified in a single machine infinite bus system and a four machine power system with PSASP6.26 (Power System Analysis Software Package). This coordinated control strategy has practical significance to improve system dynamic stability and theoretical significance to improve system transient stability.

Mobile Backhaul Solutions

In this paper, we give an overview of mobile backhaul solutions and propose an MPLS-centered solution that takes intoaccount timing synchronization, OAM, and protection： We also propose an evolved protection bandwidth allocation mechanism that makes the transport network as efficient as possible.

吲哚菁绿荧光显像技术在甲状腺手术中对甲状旁腺血供判断的应用

目的探讨甲状腺手术中吲哚菁绿(ICG)荧光显像技术判断原位保留甲状旁腺血供的应用价值。方法前瞻性纳入2017年6月1日至2018年1月1日期间因甲状腺乳头状癌(PTC)行甲状腺全切+双侧中央区淋巴结清扫术的患者并采用计算机随机分组的方法分为研究组和对照组,研究组采用ICG荧光显像技术评估甲状旁腺的血供,而对照组采用肉眼评估甲状旁腺的血供,最终根据甲状旁腺的血供确定甲状旁腺是原位保留还是自体移植,比较2组患者术后甲状旁腺功能低下发生、住院时间、甲状旁腺激素(PTH)等情况。结果①根据纳入和排除标准,本研究共纳入60例PTC患者,研究组和对照组各30例,2组患者的基线资料比较差异无统计学意义(P>0.05)。②研究组及对照组术中甲状旁腺辨认数目及其分型以及甲状旁腺自体移植数目比较差异均无统计学意义(P>0.05),A型甲状旁腺(除A3型)的ICG评分较B型甲状旁腺低(0.99±0.38比1.45±0.58,t=–2.395,P<0.05)。③术后住院时间研究组较对照组更短(t=–2.159,P=0.035)。④术后暂时性甲状旁腺功能低下发生率研究组低于对照组(χ2=5.079,P=0.024),而永久性甲状旁腺功能低下发生率2组间比较差异无统计学意义(χ2=1.000,P=0.317),仅对照组中出现1例。⑤2组术后第1天、第1个月、第3个月及第6个月的PTH、血Ca2+水平比较差异均无统计学意义(P>0.05)。结论ICG荧光显像技术可用于术中实时地判断已原位保留的甲状旁腺血供。