The 2022 Extreme Heatwave in Shanghai,Lower Reaches of the Yangtze River Valley:Combined Influences of Multiscale Variabilities

In the summer of 2022,China(especially the Yangtze River Valley,YRV)suffered its strongest heatwave(HW)event since 1961.In this study,we examined the influences of multiscale variabilities on the 2022 extreme HW in the lower reaches of the YRV,focusing on the city of Shanghai.We found that about 1/3 of the 2022 HW days in Shanghai can be attributed to the long-term warming trend of global warming.During mid-summer of 2022,an enhanced western Pacific subtropical high(WPSH)and anomalous double blockings over the Ural Mountains and Sea of Okhotsk,respectively,were associated with the persistently anomalous high pressure over the YRV,leading to the extreme HW.The Pacific Decadal Oscillation played a major role in the anomalous blocking pattern associated with the HW at the decadal time scale.Also,the positive phase of the Atlantic Multidecadal Oscillation may have contributed to regulating the formation of the double-blocking pattern.Anomalous warming of both the warm pool of the western Pacific and tropical North Atlantic at the interannual time scale may also have favored the persistency of the double blocking and the anomalously strong WPSH.At the subseasonal time scale,the anomalously frequent phases 2-5 of the canonical northward propagating variability of boreal summer intraseasonal oscillation associated with the anomalous propagation of a weak Madden-Julian Oscillation suppressed the convection over the YRV and also contributed to the HW.Therefore,the 2022 extreme HW originated from multiscale forcing including both the climate warming trend and air-sea interaction at multiple time scales.

Investigation of reflection anisotropy induced by micropipe defects on the surface of a 4H-SiC single crystal using scanning anisotropy microscopy

Optical reflection anisotropy microscopy mappings of micropipe defects on the surface of a 4H-SiC single crystal are studied by the scanning anisotropy microscopy(SAM)system.The reflection anisotropy(RA)image with a'butterfly pattern'is obtained around the micropipes by SAM.The RA image of the edge dislocations is theoretically simulated based on dislocation theory and the photoelastic principle.By comparing with the Raman spectrum,it is verified that the micropipes consist of edge dislocations.The different patterns of the RA images are due to the different orientations of the Burgers vectors.Besides,the strain distribution of the micropipes is also deduced.One can identify the dislocation type,the direction of the Burgers vector and the optical anisotropy from the RA image by using SAM.Therefore,SAM is an ideal tool to measure the optical anisotropy induced by the strain field around a defect.

Investigation on the Mechanical Properties and Shape Memory Effect of Landing Buffer Structure Based on NiTi Alloy Printing

With the deepening of human research on deep space exploration,our research on the soft landing methods of landers has gradually deepened.Adding a buffer and energy-absorbing structure to the leg structure of the lander has become an effective design solution.Based on the energy-absorbing structure of the leg of the interstellar lander,this paper studies the appearance characteristics of the predatory feet of the Odontodactylus scyllarus.The predatory feet of the Odontodactylus scyllarus can not only hit the prey highly when preying,but also can easily withstand the huge counter-impact force.The predatory feet structure of the Odontodactylus scyllarus,like a symmetrical cone,shows excellent rigidity and energy absorption capacity.Inspired by this discovery,we used SLM technology to design and manufacture two nickel-titanium samples,which respectively show high elasticity,shape memory,and get better energy absorption capacity.This research provides an effective way to design and manufacture high-mechanical energy-absorbing buffer structures using bionic 3D printing technology and nickel-titanium alloys.

Practice guidelines for ultrasound-guided percutaneous microwave ablation for hepatic malignancy

Primary liver cancer and liver metastases are among the most frequent malignancies worldwide,with an increasing number of new cases and deaths every year.Traditional surgery is only suitable for a limited proportion of patients and imaging-guided percutaneous thermal ablation has achieved optimistic results for management of hepatic malignancy.This synopsis outlines the first clinical practice guidelines for ultrasoundguided percutaneous microwave ablation therapy for hepatic malignancy,which was created by a joint task force of the Society of Chinese Interventional Ultrasound.The guidelines aim at standardizing the microwave ablation procedure and therapeutic efficacy assessment,as well as proposing the criteria for the treatment candidates.

The Long-term Variation of Extreme Heavy Precipitation and Its Link to Urbanization Effects in Shanghai during 1916–2014

Using the hourly precipitation records of meteorological stations in Shanghai, covering a period of almost a century （1916-2014）, the long-term variation of extreme heavy precipitation in Shanghai on multiple spatial and temporal scales is analyzed, and the effects of urbanization on hourly rainstorms studied. Results show that： （1） Over the last century, extreme hourly precipitation events enhanced significantly. During the recent urbanization period from 1981 to 2014, the frequency of heavy precipitation increased significantly, with a distinct localized and abrupt characteristic. （2） The spatial distribution of long-term trends for the occurrence frequency and total precipitation intensity of hourly heavy precipitation in Shanghai shows a distinct urban rain-island feature; namely, heavy precipitation was increasingly focused in urban and suburban areas. Attribution analysis shows that urbanization in Shanghai contributed greatly to the increase in both frequency and intensity of heavy rainfall events in the city, thus leading to an increasing total precipitation amount of heavy rainfall events. In addition, the diurnal variation of rainfall intensity also shows distinctive urban-rural differences, especially during late afternoon and early nighttime in the city area. （3） Regional warming, with subsequent enhancement of water vapor content, convergence of moisture flux and atmospheric instability, provided favorable physical backgrounds for the formation of extreme precipitation. This accounts for the consistent increase in hourly heavy precipitation over the whole Shanghai area during recent times.

Effect of hydrogen on the stress corrosion cracking behavior of X80 pipeline steel in Ku'erle soil simulated solution

Hydrogen was a key factor resulting in stress corrosion cracking （SCC） of X80 pipeline steel in Ku＇erle soil simulated solution. In this article, the effect of hydrogen on the SCC susceptibility of X80 steel was investigated further by slow strain rate tensile test, the surface fractures were observed using scanning electron microscopy （SEM）, and the fracture mechanism of SCC was discussed. The results indicate that hydrogen increases the SCC susceptibility. The SEM micrographs of hydrogen precharged samples presents a brittle quasi-cleavage feature, and pits facilitate the transgranular crack initiation. In the electrochemical impedance spectroscopy （EIS） measurement, the decreased polarization resistance and the pitting resistance of samples with hydrogen indicate that hydrogen increases the dissolution rate and deteriorates the pitting corrosion resistance. The potentiodynamic polarization curves present that hydrogen also accelerates the dissolution rate of the crack tip.

Stereotactic body radiotherapy using Cyber Knife for locally advanced unresectable and metastatic pancreatic cancer

AIM: To evaluate the efficacy and toxicity of stereotactic body radiotherapy using Cyber Knife for locally advanced unresectable and metastatic pancreatic cancer.METHODS: From June 2010 to May 2014,25 patients with locally advanced unresectable and metastatic pancreatic cancer underwent stereotactic body radiotherapy.Nine patients presented with unresectable locally advanced disease and 16 had metastatic disease.Primary end-points of this study were overall survival,relief of abdominal pain,and toxicity.RESULTS: Fourteen patients were treated with a total dose of 30-36 Gy in three fractions and the remainder with 40-48 Gy in four fractions.Median follow-up was 11 mo(range: 2-25 mo).The median survival duration calculated from the time of stereotactic body radiotherapy for the entire group,the locally advanced group,and the metastatic group was 9.0 mo,13.5 mo,and 8.5 mo,respectively.Overall survival was 37% and 18% at one and two years,respectively.Abdominal pain relief was achieved within 2 wk of completing radiotherapy in the patients who received successful palliation(13 of 20 patients had significant pain).Five patients(20%) had grade 1 nausea,and one(4%) had grade 2 nausea.No acute grade 3+ toxicity was seen.CONCLUSION: Stereotactic body radiotherapy using the Cyber Knife system is a promising,noninvasive,palliative treatment with acceptable toxicity for locally advanced unresectable and metastatic pancreatic cancer.

The Extreme Mei-yu Season in 2020:Role of the Madden-Julian Oscillation and the Cooperative Influence of the Pacific and Indian Oceans

The middle and lower reaches of the Yangtze River in eastern China during summer 2020 suffered the strongest mei-yu since 1961.In this work,we comprehensively analyzed the mechanism of the extreme mei-yu season in 2020,with focuses on the combined effects of the Madden-Julian Oscillation(MJO)and the cooperative influence of the Pacific and Indian Oceans in 2020 and from a historical perspective.The prediction and predictability of the extreme mei-yu are further investigated by assessing the performances of the climate model operational predictions and simulations.It is noted that persistent MJO phases 1−2 during June−July 2020 played a crucial role for the extreme mei-yu by strengthening the western Pacific subtropical high.Both the development of La Niña conditions and sea surface temperature(SST)warming in the tropical Indian Ocean exerted important influences on the long-lived MJO phases 1−2 by slowing down the eastward propagation of the MJO and activating convection related to the MJO over the tropical Indian Ocean.The spatial distribution of the 2020 mei-yu can be qualitatively captured in model real-time forecasts with a one-month lead.This can be attributed to the contributions of both the tropical Indian Ocean warming and La Niña development.Nevertheless,the mei-yu rainfall amounts are seriously underestimated.Model simulations forced with observed SST suggest that internal processes of the atmosphere play a more important role than boundary forcing(e.g.,SST)in the variability of mei-yu anomaly,implying a challenge in quantitatively predicting an extreme mei-yu season,like the one in 2020.

Composite Configuration Interventional Therapy Robot for the Microwave Ablation of Liver Tumors

The existing interventional therapy robots for the microwave ablation of liver tumors have a poor clinical applicability with a large volume, low positioning speed and complex automatic navigation control. To solve above problems, a composite configuration interventional therapy robot with passive and active joints is developed. The design of composite configuration reduces the size of the robot under the premise of a wide range of movement, and the robot with composite configuration can realizes rapid positioning with operation safety. The cumulative error of positioning is eliminated and the control complexity is reduced by decoupling active parts. The navigation algo- rithms for the robot are proposed based on solution of the inverse kinematics and geometric analysis. A simulation clinical test method is designed for the robot, and the functions of the robot and the navigation algorithms are verified by the test method. The mean error of navigation is 1.488 mm and the maximum error is 2.056 mm, and thepositioning time for the ablation needle is in 10 s. The experimental results show that the designed robot can meet the clinical requirements for the microwave ablation of liver tumors. The composite configuration is proposed in development of the interventional therapy robot for the microwave ablation of liver tumors, which provides a new idea for the structural design of medical robots.

Nomogram based on albumin-bilirubin grade to predict outcome of the patients with hepatitis C virus-related hepatocellular carcinoma after microwave ablation

Objective:To construct a nomogram based on the albumin-bilirubin(ALBI)grade to provide prognostic value for hepatitis C virus(HCV)-related hepatocellular carcinoma(HCC)patients who underwent ultrasound-guided percutaneous microwave ablation(US-PMWA).Methods:From April 2005 to January 2018,183 treatment-naIve patients with 251 HCV-related HCCs according to the Milan criteria received US-PMWA subsequently.The overall survival(OS)and recurrence-free survival(RFS)were compared between groups classified by ALBI grade.Cox proportional hazard regression model based on risk factors for survival and recurrence was used to construct the nomogram.Results:The cumulative OS rates at 1-,3-,5-and 10-year were 97.7%,73.6%,54.5%and 34.5%,respectively.Stratified according to ALBI grade,the 1-,3-,and 5-year OS in the ALBI grade 1 group and grade 2 group were 99.2%,92.4%,77.9% and 97.7%,52.3%,38.6%,respectively,with significant statistical difference(P<0.001).No significant statistical difference was detected in the1-,3-,and 5-year RFS rates in the ALBI grade 1 group and grade 2 group(P=0.220).The major complication rate was 1.6%.Multivariate analysis results showed age,α-fetoprotein level,tumor number,platelet count,location,Child-Turcotte-Pugh(CTP)and ALBI grade were associated with OS,which generated the nomograms.Internal validation with 1000 bootstrapped sample sets had good concordance index of 0.769(95%CI 0.699-0.839)in OS.Conclusions:This nomogram based on ALBI grade was a visualization risk model,which could provide personalized prediction of long-term outcomes for HCV-related HCC patients after US-PMWA.

Characterization of primary hepatic carcinosarcoma by contrast-enhanced ultrasonography: A case report

Primary hepatic carcinosarcoma is a rare tumor and is comprised of a mixture of carcinomatous and sarcomatous elements. We present a case of primary carcinosarcoma of the liver in a 59-year-old woman, which was confirmed by pathology following surgical resection. Using contrast-enhanced ultrasonography, the tumor showed peripheral nodular hyperenhancement in the arterial phase with two feeding arterial vessels and a large internal non-enhancing portion in the center. The peripheral nodular portion of the tumor showed hypoenhancement in the later phase.

Effects of solution environments under disbonded coatings on the corrosion behaviors of X70 pipeline steel in acidic soils

A rectangle crevice assembly was used to study the effects of cathodic protection （CP） potential, crevice thickness, holiday size, bubbling CO2, and surface condition on the chemical and electrochemical environment of the local solution under disbonded coatings. It is found that the cathodic protection removes dissolved oxygen from the crevice and thus shifts the solution to a more al- kaline state. Furthermore, the potential of the steel reaches the protected potential range. The available protection distance increases with the negative applying potential. The steady potential and pH distribution are easily achieved, but the polarization degree is not satisfied within the thinner crevice. The difference in the solution environment is found to correlate to the holiday size. The smaller the holiday, the smaller the difference is. The presence of CO2 inhibits the formation of an alkaline environment. It is also found that the rust layer dramatically decreases the polarization rate in the crevice.

Cholecystectomy is associated with higher risk of recurrence after microwave ablation of hepatocellular carcinoma:a propensity score matching analysis

Objective:To explore the association between cholecystectomy and the prognostic outcomes of patients with hepatocellular carcinoma(H CC)who underwent microwave ablation(MWA).Methods:Patients with HCC(«=921)who underwent MWA were included and divided into cholecystectomy(n=114)and non-cholecystectomy groups(n=807).After propensity score matching(PSM)at a 1:2 ratio,overall survival(OS)and disease-free survival(DFS)rates were analyzed to compare prognostic outcomes between the cholecystectomy(«=114)and non-cholecystectomy groups(n=228).Univariate and multivariate Cox analyses were performed to assess potential risk factors for OS and DFS.Major complications were also compared between the groups.Results:After matching,no significant differences between groups were observed in baseline characteristics.The 1-,3-,and 5-year OS rates were 96.5%,82.1%,and 67.1%in the cholecystectomy group,and 97.4%,85.2%,and 74.4%in the non-cholecystectomy group(P=0.396);the 1-,3-,and 5-year DFS rates were 58.4%,34.5%,and 26.6%in the cholecystectomy group,and 73.6%,44.7%,and 32.2%in the non-cholecystectomy group(P=0.026),respectively.The intrahepatic distant recurrence rate in the cholecystectomy group was significantly higher than that in the non-cholecystectomy group(P=0.026),and the local tumor recurrence and extrahepatic recurrence rates did not significantly differ between the groups(P=0.609 and P=0.879).Multivariate analysis revealed that cholecystectomy(HR=1.364,95%Cl 1.023-1.819,P=0.035),number of tumors(2 vs.1:HR=2.744,95%Cl 1.925-3.912,P<0.001;3 vs.1:HR=3.411,95%Cl 2.021-5.759,P<0.001),and y-GT levels(HR=1.003,95%Cl 1.000-1.006,P<0.024)were independent risk factors for DFS.The best y-GT level cut-off value for predicting median DFS was 39.6 U/L(area under the curve=0.600,P<0.05).A positive correlation was observed between cholecystectomy and y-GT level(r=0.108,95%Cl-0.001-0.214,P=0.047).Subgroup analysis showed that the DFS rates were significantly higher in the non-cholecystectomy group than the cholecystectomy group when Y-GT>39.6 U/L(i3=0.044).The 5-,10-,15-,20-,and 25-year recurrence rates from the time of cholecystectomy were 2.63%,21.93%,42.11%,58.77%,and 65.79%,respectively.A significant positive correlation was observed between cholecystectomy and the time from cholecystectomy to recurrence(r=0.205,95%Cl 0.016-0.379,P=0.029).There were no significant differences in complications between groups(P=0.685).Conclusions:Patients with HCC who underwent cholecystectomy were more likely to develop intrahepatic distant recurrence after MWA,an outcome probably associated with increased y-GT levels.Moreover,the recurrence rates increased with time.

Frequency of presenting visual acuity and visual impairment in Chinese college students

AIM:To obtain the baseline data on presenting visual acuity(PVA)and evaluate the prevalence and associated factors for visual impairment based on PVA in 9070 Chinese college students.METHODS:The freshmen at a university in southern China,including 6527 undergraduate students and 2543 graduate students,were investigated for some sociodemographic characteristics and underwent routine medical examination,including measuring PVA,height,and weight.Visual impairment was defined according to the new World Health Organization criteria for blindness and visual impairment.RESULTS:In 9070 college students,the mean PVA in the better eye was 0.094±0.163 log MAR.The prevalence of visual impairment based on PVA was 2.7%.Only 38.3%college students had normal visual acuity[PVA equal to 0 log MAR(20/20)in both eyes].There were 69.8%of students wearing spectacles.Logistic regression showed that home region(non-Guangdong provinces,P<0.0001,OR=1.70)was risk factor for visual impairment while BMI(P=0.001,OR=0.92)was protective factor from visual impairment.Ethnicity(Han Chinese,P<0.0001,OR=3.17)was risk factor for wearing spectacles while age(P=0.01,OR=0.90)was protective factor from wearing spectacles.CONCLUSION:This study provides the baseline data on PVA and the prevalence of visual impairment in Chinese college students.Our analyses reveal that BMI and home region are associated factors for visual impairment based on PVA,while age and ethnicity are associated factors for wearing spectacles.

Ultrasound-guided microwave ablation for abdominal wall metastatic tumors: A preliminary study

AIM: To evaluate the feasibility, safety and efficacy of ultrasound-guided microwave (MW) ablation for abdominal wall metastatic tumors. METHODS: From August 2007 to December 2010, a total of 11 patients with 23 abdominal wall nodules (diameter 2.59 cm ± 1.11 cm, range 1.3 cm to 5.0 cm) were treated with MW ablation. One antenna was inserted into the center of tumors less than 1.7 cm, and multiple antennae were inserted simultaneously into tumors 1.7 cm or larger. A 21 gauge thermocouple was inserted near important organs which required protection (such as bowel or gallbladder) for real-time temperature monitoring during MW ablation. Treatment outcome was observed by contrast-enhanced ultrasound and magnetic resonance imaging (MRI) [or computed tomography (CT)] during follow-up. RESULTS: MW ablation was well tolerated by all patients. Six patients with 11 nodules had 1 thermocouple inserted near important organs for real-time temperature monitoring and the maximum temperature was 56 ℃. Major complications included mild pain (54.5%), post-ablation fever (100%) and abdominal wall edema (25%). All 23 tumors (100%) in this group were completely ablated, and no residual tumor or local recurrence was observed at a median follow-up of 13 mo (range 1 to 32 mo). The ablation zone was well defined on contrast-enhanced imaging (contrast-enhanced CT, MRI and/or contrast-enhanced ultrasound) and gradually shrank with time. CONCLUSION: Ultrasound-guided MW ablation may be a feasible, safe and effective treatment for abdominal wall metastatic tumors in selected patients.

Chinese clinical practice guidelines for ultrasound-guided irreversible electroporation of liver cancer(version 2022)

Introduction Liver cancer remains a global health challenge,and its incidence is increasing worldwide.It is estimated that by 2025,more than one million individuals will be affected by liver cancer annually[1,2].In recent years,ablation has become a widely accepted treatment option for patients with primary and secondary liver malignancies[3].The commonly used ablation method for liver cancer is thermal ablation,including radiofrequency ablation.

Assessment of hepatic VX_2 tumors with combined percutaneous transhepatic lymphosonography and contrast-enhanced ultrasonographic imaging

AIM： To evaluate the feasibility and efficacy of percutaneous transhepatic lymphosonography （PTL） as a novel method for the detection of tumor lymphangiogenesis in hepatic VX2 of rabbits and to evaluate combined PTL and routine contrast-enhanced ultrasonographic imaging for the diagnosis of liver cancer. METHODS： Ten rabbits with VX2 tumor were included in this study. SonoVue （0.1 mL/kg） was injected into each rabbit via an ear vein for contrast-enhanced ultrasonographic imaging, and 0.5 mL SonoVue was injected into the normal liver parenchyma near the VX2 tumor for PTL. Images and/or movie clips were stored for further analysis. RESULTS： UItrasonographic imaging showed VX2 tumors ranging 5-19 mm in the liver of rabbits. The VX2 tumor was hyperechoic and hypoechoic to liver parenchyma at the early and later phase, respectively. The hepatic lymph vessels were visualized immediately after injection of contrast medium and continuously vi- sualized with SonoVue during PTL. The boundaries of VX2 tumors were hyperechoic to liver parenchyma and the tumors. There was a significant difference in the values for the boundaries of VX2 tumors after injection compared with the liver normal parenchyma and the tumor parenchyma during PTL.CONCLUSION： PTL is a novel method for the detection of tumor lymphangiogenesis in hepatic VX2 of rabbits. Combined PTL and contrast-enhanced ultrasonographic imaging can improve the diagnosis of liver cancer.

Establishing models of portal vein occlusion and evaluating value of multi-slice CT in hepatic VX2 tumor in rabbits

AIM： To establish models of portal vein occlusion of hepatic VX2 tumor in rabbits and to evaluate the value of multi-slice CT. METHODS： Forty New Zealand rabbits were divided into 4 groups according to digital table： Immediate group （group A; transplantation of tumor immediately after the portal vein occlusion）, 3-wk group （group B; transplantation of tumor at 3 wk after the portal vein occlusion）, negative control group （group C） and positive control group （group D）, 10 rabbits in each group. Hepatic VX2 tumor was transplanted with abdominalembedding innoculation immediately after the portal vein occlusion and at 3 wk after the portal vein occlusion. Meanwhile, they were divided into negative control group （Left external branch of portal vein was occluded by sham-operation, and left exite was embedded and inoculated pseudoly） and positive control group （Transplanted tumor did not suffer from the portal vein occlusion）. All rabbits were scanned with multi-slice CT. RESULTS： All 40 animals were employed in the final analysis without death. Tumor did not grow in both immediate group and 3-wk group. In 3-wk group, left endite was atrophied and growth of tumor was inhibited. The maximal diameter of tumor was significantly smaller than that in positive control group （2.55±0.46 vs 3.59±0.37 cm, t = 5.57, P 〈 0.001）. Incidences of metastasis in the liver and lung were lower in 3-wk group than those in positive control group （10% vs 400, and 90% vs 100%, respectively）. The expression intensities of the vascular endothelium growth factor （VEGF） in groups A, B, C and D were 0.10±0.06, 0.66±0.21, 0.28±0.09 and 1.48±0.32, respectively. VEGF expression level in the test group A was significantly lower than that in the negative control group C （t = 5.07; P 〈 0.001）.In addition, VEGF expression in the test group B was significantly lower than that in the positive control group D （t = 6.38; P 〈 0.001）. Scanning with multi-slice CT showed that displaying rate of hepatic artery branches was obviously lower in grade Ⅲ（40%） than that in grade Ⅰ（70%） and Ⅱ（100%） （P 〈 0.05）; but there was no significant difference in displaying rate of the portal vein at various grades. Values of blood flow （BF） of the liver, blood volume （BV）, mean transit time （MTT） and permeability of vascular surface （PS） were lower in the immediate group and 3-wk group than those in control groups, but values of hepatic arterial fraction （HAF） were increased. Significant positive correlations were existed between BF and BV （r = 0.905, P 〈 0.01）, and between BF and PS （r = 0.967, P 〈 0.01）, between BV and PS （r = 0.889, P 〈 0.01）. A significant negative correlation existed between PV and HAF （r = -0.768, P 〈 0.01）, between PS and HAF （r = -0.557, P 〈 0.01）. The values of BF, BV and PS had a positive correlation with VEGF （rBF = 0.842, rBV = 0.579, rPS = 0.811, P 〈 0.01） . However, there was no significant correlation between the values of MTT and HAF and the VEGF expression （rMTt = 0.066, rHAF = -0.027）. CONCLUSION： Ligating the left external branch of portal vein is an ideal way to establish models of portal vein occlusion in rabbits with hepatic VX2 tumor. Multi slice CT plays a key role in evaluating effect of portal vein occlusion.

Pulmonary lymphomatoid granulomatosis in a 4-year-old girl:A case report

BACKGROUND Pulmonary lymphomatoid granulomatosis(PLG)is a lymphoproliferative disease associated with Epstein-Barr viral infection occurring mainly in adults and rarely in children.It is characterized by multiple pulmonary nodules.Its diagnosis depends on lung biopsy findings.Most patients are immunodeficient,and it commonly presents in children undergoing chemotherapy for leukemia.We report the case of a child with PLG caused by a mutation in the macrophageexpressed gene 1(MPEG1),suggesting possible PLG occurrence in children undergoing treatment for pulmonary nodular lesions.CASE SUMMARY This study reports a case of PLG without apparent immunodeficiency,suggesting the possibility of this disease occurrence during the treatment of pulmonary nodular lesions in children.Initially,the cause was assumed to be an atypical pathogen.Following conventional anti-infective treatment,chest computed tomography findings revealed that there were still multiple nodules in the lungs.Additionally,the patient was found to be infected with the Epstein-Barr virus.Histopathological examination of the resected lung revealed lymphoproliferative lesions with necrosis.Small lymphocytes,plasma cells,and histiocytes were observed in the background,although Reed-Sternberg cells were absent.Immunohistochemical staining[CD20(+),CD30(+),and CD3(+)]and EBV-encoded small RNA1/2 in situ hybridization of small lymphocytes revealed approximately 200 cells/high-power field.Whole exon sequencing of the patient revealed a mutation in the MPEG1.The patient was eventually diagnosed with PLG and transferred to the Department of Pediatric Oncology for bone marrow transplantation.CONCLUSION As PLG is rare and fatal,it should be suspected in clinical settings when treatment of initial diagnosis is ineffective.

Microwave ablation vs. surgical resection for treatment naïve hepatocellular carcinoma within the Milan criteria: a follow-up of at least 5 years

Objective:Thermal ablation poses challenges in the surgical resection(SR)of small hepatocellular carcinoma(HCC),and its therapeutic outcomes for larger lesions remain debated.Methods:This retrospective study evaluated 729 patients with HCC meeting the Milan criteria,who were treated with curative SR or microwave ablation(MWA)between 2008 and 2014.Overall survival(OS),cancer-specific survival(CSS),disease-free survival(DFS),and local tumor progression(LTP)were compared after propensity score matching(PSM).Co-variates associated with OS,CSS,LTP,and DFS were identified.The risk of death and tumor progression were compared.Results:During the median follow-up of 78.6 months,253 patients were included in each group after PSM.For tumors≤3.0 cm and 3.1–4.0 cm,MWA achieved comparable results in terms of OS,CSS,DFS,and LTP.For tumors 4.1–5.0 cm,MWA had lower OS,CSS,and DFS rates(all P<0.05)than SR.Higher LTP rates were observed in the MWA group for tumors 4.1–5.0 cm,although the difference was not significant(P=0.18).Complication rates(P=0.41)were similar,but MWA led to less estimated blood loss(P<0.01)and shorter postoperative hospitalization times(P<0.01).Conclusions:MWA achieved comparable long-term oncologic outcomes with SR for≤4 cm HCC,with lower complication rates and faster recovery.