Endoscopic Surgery versus External Ventricular Drainage Surgery for Severe Intraventricular Hemorrhage

The efficacy and applied value of endoscopic hematoma evacuation vs. external ventricular drainage (EVD) in the treatment of severe ventficular hemorrhage (IVH) were explored and compared.From Jan.2015 to Dec.2016,the clinical data of 42 cases of IVH were retrospectively analyzed,including 18 patients undergoing endoscopic hematoma evacuation (group A),and 24patients receiving EVD (group B).The hematoma clearance rate was calculated by 3D Slicer software,and complications and outcomes were compared between the two groups.There were no significant differences in age,sex and Graeb score between groups A and B (P>0.05).The hematoma clearance rate was 70.81%±27.64% in group A and 48.72%±36.58% in group B with a statistically significant difference (P<0.05).The operative time in groups A and B was 72.45±25.26 min and 28.54±15.27min,respectively (P<0.05).The Glasgow Coma Scale (GCS) score increased from 9.28±2.72 at baseline to 11.83±2.91 at 1 week postoperatively in group A,and from 8.25±2.62 at baseline to 10.79±4.12 at 1 week postoperatively in group B (P<0.05).The length of hospital stay was 12.67±5.97 days in group A and 17.33±8.91 days in group B with a statistically significant difference (P<0.05).The GOS scores at 6 months after surgery were 3.83±1.12 in group A,and 2.75±1.23 in group B (P<0.05). These results suggested that endoscopic hematoma evacuation has an advantage of a higher hematoma clearance rate,fewer complications and better outcomes in the treatment of severe IVH,indicating it is a safe,effective and promising approach for severe IVH.

Outcomes of per oral endoscopic pyloromyotomy in gastroparesis worldwide

Per oral endoscopic pyloromyotomy(POP),also known as gastric per-oral endoscopic myotomy(GPOEM),is a novel procedure with promising potential for the treatment of gastroparesis.As more data emerge and the procedure is becoming more recognized in clinical practice,its safety and efficacy need to be carefully evaluated.Appropriate patient selection for favorable clinical success prediction after GPOEM also needs additional research.This review aims to systemically summarize the existing data on clinical outcomes of POP.Symptomatologic responses to the procedure,its adverse effects,procedural techniques,and predictive factors of clinical success are also discussed.

A review of clinical and histological parameters associated with contralateral neck metastases in oral squamous cell carcinoma

Oral squamous cell carcinoma （OSCC） has a high incidence of cervical micrometastases and sometimes metastasizes contralaterally because of the rich lymphatic intercommunications relative to submucosal plexus of oral cavity that freely communicate across the midline, and it can facilitate the spread of neoplastic cells to any area of the neck consequently. Clinical and histopathologic factors continue to provide predictive information to contralateral neck metastases （CLNM） in OSCC, which determine prophylactic and adjuvant treatments for an individual patient. This review describes the predictive value of clinical-histopathologic factors, which relate to primary tumor and cervical lymph nodes, and surgical dissection and adjuvant treatments. In addition, the indications for elective contralateral neck dissection and adjuvant radiotherapy （aRT） and strategies for follow-up are offered, which is strongly focused by clinicians to prevent later CLNM and poor prognosis subsequently.

Clinical significance of main pancreatic duct dilation on computed tomography: Single and double duct dilation

AIM: To study the patients with main pancreatic duct dilation on computed tomography (CT) and thereby to provide the predictive criteria to identify patients at high risk of significant diseases, such as pancreatic cancer, and to avoid unnecessary work up for patients at low risk of such diseases. METHODS: Patients with dilation of the main pancreatic duct on CT at Emory University Hospital in 2002 were identified by computer search. Clinical course and ultimate diagnosis were obtained in all the identified patients by abstraction of their computer database records. RESULTS: Seventy-seven patients were identified in this study. Chronic pancreatitis and pancreatic cancer were the most common causes of the main pancreatic duct dilation on CT. Although the majority of patients with isolated dilation of the main pancreatic duct (single duct dilation) had chronic pancreatitis, one-third of patients with single duct dilation but without chronic pancreatitis had pancreatic malignancies, whereas most of patients with concomitant biliary duct dilation (double duct dilation) had pancreatic cancer. CONCLUSION: Patients with pancreatic double duct dilation need extensive work up and careful followup since a majority of these patients are ultimately diagnosed with pancreatic cancer. Patients with single duct dilation, especially such patients without any evidence of chronic pancreatitis, also need careful follow-up since the possibility of pancreatic malignancy, including adenocarcinoma and intraductal papillary mucinous tumors, is still high.

D-dimer may predict poor outcomes in patients with aneurysmal subarachnoid hemorrhage: a retrospective study

Serum biomarkers may play a reliable role in predicting the outcomes of patients with aneurysmal subarachnoid hemorrhage. This study retrospectively analyzed the relationship between serum biomarkers on admission and outcomes in patients with aneurysmal subarachnoid hemorrhage. We recruited 146 patients with aneurysmal subarachnoid hemorrhage who were treated in Renmin Hospital of Wuhan University of China between 1 May 2014 and 30 March 2016. There were 57 males and 89 females included and average age of included patients was 57.03 years old. Serum samples were taken immediately on admission（within 48 hours after initial hemorrhage） and the levels of serum biomarkers were detected. Baseline information, complications, and outcomes at 6 months were recorded. Univariate and multivariate logistic regression analyses were used to explore the relationship between biomarkers and clinical outcomes. Receiver operating characteristic curves were obtained to investigate the possibility of the biomarkers predicting prognosis. Of the 146 patients, 102 patients achieved good outcomes and 44 patients had poor outcomes. Univariate and multivariate analyses showed that high World Federation of Neurosurgical Societies grade, high serum D-dimer levels, and high neurological complications were significantly associated with poor outcomes. Receiver operating characteristic curves verified that D-dimer levels were associated with poor outcomes. D-dimer levels strongly correlated with neurological complications. In conclusion, we suggest that D-dimer levels are a good independent prognostic factor for poor outcomes in patients with aneurysmal subarachnoid hemorrhage.

Increased leucine-rich repeats and immunoglobulin- like domains 1 expression enhances chemosensitivity in glioma

Leucine-rich repeats and immunoglobulin-like domains 1 （LRIG1） is an anti-oncogene. LRIG1 is correlated with Bcl-2 in ependymomas. Decreased Bcl-2 and manganese superoxide dismutase expression can improve the chemosensitivity of glioma. In the present study, a tissue microarray of human brain astrocytomas was constructed. To investigate the relationship of LRIG1 with Bcl-2 and manganese superoxide dismutase, LRIG1, Bcl-2 and manganese superoxide dismutase expression in our tissue microarray was determined using immunohistochemistry. In addition, we constructed the LRIG1-U251 cell line, and its responses to doxorubicin and temozolomide were detected using the MTT assay. Results showed that LRIG1 expression was significantly negatively correlated with Bcl-2 and manganese superoxide dismutase expression in glioma. Also, proliferation of LRIG1-U251 cells exposed to doxorubicin or temozolomide was significantly inhibited, i.e. in the LRIG1-U251 cell line, the chemosensitivity to doxorubicin and temozolomide was increased. This indicates that increased LRIG1 expression produces a chemosensitivity in glioma.

Same site submucosal tunneling for a repeat per oral endoscopic myotomy: a safe and feasible option

Per oral endoscopic myotomy(POEM) is a novel endoscopic procedure for achalasia treatment. Due to its novelty and high success rates, a repeat procedure is usually not warranted, making the feasibility and safety of such approach unknown. We report the first case of a successful repeat POEM done at the same site of a previously uncompleted POEM. An 84-year-old female with type 2 achalasia presented for a POEM procedure. The procedure was aborted at the end of tunneling and before myotomy due to hypotension, which later resolved spontaneously. POEM was re-attempted at the same site of the original tunnel 1 year afterward, and surprisingly we didn't encounter any submucosal fibrosis. The procedure felt similar to a native POEM and a myotomy was performed uneventfully. Our case is the first to suggest that submucosal tunneling during a repeat POEM can be done at the same site. Hypotension during POEM is a rare complication that should be recognized as a potential result of tension capnothorax, it can however, be managed with close supportive care.

Snow disaster characteristics in Palongzangbu River Basinand mitigation countermeasures for road engineering

The Palongzangbu River Basin contains the highest number of maritime province glaciers in China. There are 130 glacial lakes, 64 snow avalanche sites and 28 glacial debris flow gullies distributed within the basin. Snow disasters play a controlling role in the Sichuan-Tibet Highway construction, due to the terrain’s special characteristics of high altitude and large height differential. Segmentation mitigation countermeasures for the Sichuan-Tibet Highway are presented based on snow disaster severity level and damage mode of the road. In the Ranwu to Midui section, snow avalanches are regional disasters, so the line should be placed in sunny slopes. In the Midui Gully to Yupu section, the line should be placed in shady slopes and at higher elevations to reduce the risk of glacial lake outburst. In the Yupu to Guxiang section, all three snow disasters are minimal. In the Guxiang to Tongmai section, glacier debris flows are the major threat, thus the road should be placed in shady slopes.

胆胰汇合异常与胆管扩张症的研究进展

胆胰汇合异常(pancreaticobiliary maljunction,PBM)是胰管和胆管在胚胎时期开始在十二指肠壁外连接,由此形成胆汁和胰液异常返流并产生相应的临床症状的一类先天性疾病.PBM是胆道恶性肿瘤的高危因素.PBM可伴有或不伴有胆管扩张症(biliary dilatation,BD).早期诊断PBM有助于预防相关并发症;超声、磁共振、螺旋CT、内镜超声、内窥镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)、胆道造影等是重要的诊断手段.胆管囊肿完全切除和胆肠重建术是治疗PBM合并BD的标准术式;不合并胆管扩张症的PBM应及时行胆囊切除术.

Effects of dexmedetomidine combined with ultrasound-guided nerve block on hemodynamics, immune function and cortisol levels in patients undergoing inguinal surgery

Objective:To investigate the effect of dexmedetomidine combined with ultrasound guided nerve block on the hemodynamics, immune function and cortisol level in the patients undergoing inguinal surgery.Methods:A total of 120 patients who underwent unilateral inguinal surgery in our hospital were randomly divided into control group and observation group, 60 cases in each group. The control group was induced by intravenous anesthesia with sufentanil. The observation group was given dexmedetomidine combined with ultrasound guided ilioinguinal/iliac hypogastric nerve block. Hemodynamics, immune function and cortisol levels were compared between the two groups before and after anesthesia induction. Results:After anesthesia, in surgical incision and recovery time, the levels of HR in the two groups were significantly lower than that before the anesthesia, and the levels of HR in the observation group were significantly lower than that in the control group. After anesthesia, in surgical incision and recovery time, the levels of CD3+, CD4+ and CD4+/CD8+ in the control group were significantly lower than that of the group before anesthesia. After anesthesia, the levels of CD3+, CD4+ and CD4+/CD8+ in the observation group were significantly lower than that of the group before anesthesia. In surgical incision and recovery time, there was no significant difference in the levels of CD3+, CD4+ and CD4+/CD8+ in the observation group before anesthesia. After anesthesia, in surgical incision and recovery time, the levels of CD3+, CD4+ and CD4+/CD8+ in the observation group were significantly higher than that of the control group. The levels of serum PI3K, ET -1, CRP and cortisol of the two groups were significantly higher than those before anesthesia, and the levels of PI3K, ET -1, CRP and cortisol in the serum of the patients in the observation group were significantly lower than those in the control group.Conclusion: The effect of dexmedetomidin combined with ultrasound guided nerve block anesthesia on the patients with inguinal surgery can effectively maintain the hemodynamic stability of the patients and have less influence on the immune function and the stress response. The security is higher.

Pre-activated macrophage membrane-encased aggregationinduced emission featuring nanoparticles:a novel possibility for tuberculosis treatment

In a recent study published in Nature Nanotechnology,Li et al.introduce the synthesis of a novel photosensitizer with unique aggregation-induced emission(AIE)characteristics.1 They microencapsulated this photosensitizer inside engineered nanoparticles(NPs)coated with pre-activated macrophage cell membranes(CMs),an innovative approach marking a significant leap in nanomedicine by offering a pathway to potent tuberculosis(TB)treatments that bypass antibiotic resistance with unparalleled precision.

Interactions of OsMADS1 with Floral Homeotic Genes in Rice Flower Development

During reproductive development, rice plants develop unique flower organs which determine the final grain yield. OsMADS1, one of SEPALLATA-like MADS-box genes, has been unraveled to play critical roles in rice floral organ identity specification and floral meristem determinacy. However, the molecular mechanisms underlying interactions of OsMADS1 with other floral homeotic genes in regulating flower development remains largely elusive. In this work, we studied the genetic interactions of OsMADS1 with B-, C-, and D-class genes along with physical interactions among their proteins. We show that the physical and genetic interactions between OsMADS1 and OsMADS3 are essential for floral meristem activity maintenance and organ identity specification; while OsMADS1 physically and genetically interacts with OsMADS58 in regu- lating floral meristem determinacy and suppressing spikelet meristem reversion. We provided important genetic evidence to support the neofunctionalization of two rice C-class genes （OsMADS3 and OsMADS58） during flower development. Gene expression profiling and quantitative RT-PCR analyses further revealed that OsMADS1 affects the expression of many genes involved in floral identity and hormone signaling, and chromatin immunoprecipitation （ChlP）-PCR assay further demonstrated that OsMADS17 is a direct target gene of OsMADS1. Taken together, these results reveal that OsMADS1 has diversified regulatory functions in specifying rice floral organ and meristem identity, probably through its genetic and physical interactions with different floral homeotic regulators.

Effective methods for isolation and purification of extracellular vesicles from plants

Plant extracellular vesicles(EVs)play critical roles in the cross-kingdom trafficking of molecules from hosts to interacting microbes,most notably in plant defense responses.However,the isolation of pure,intact EVs from plants remains challenging.A variety of methods have been utilized to isolate plant EVs from apoplastic washing fluid(AWF).Here,we compare published plant EV isolation methods,and provide our recommended method for the isolation and purification of plant EVs.This method includes a detailed protocol for clean AWF collection from Arabidopsis thaliana leaves,followed by EV isolation via differential centrifugation.To further separate and purify specific subclasses of EVs from heterogeneous vesicle populations,density gradient ultracentrifugation and immunoaffinity capture are then utilized.We found that immunoaffinity capture is the most precise method for specific EV subclass isolation when suitable specific EV biomarkers and their corresponding antibodies are available.Overall,this study provides a guide for the selection and optimization of EV isolation methods for desired downstream applications.

Doxorubicin-Ioaded Fe3O4@MoS2-PEG-2DG nanocubes as a theranostic platform for magnetic resonance imaging- guided chemo-photothermal therapy of breast cancer

Molybdenum disulfide （MoS2）, a typical transition-metal dichalcogenide, has attracted increasing attention in the field of nanomedicine because of its preeminent properties. In this study, magnetic resonance imaging （MRI）-guided chemo-photothermal therapy of human breast cancer xenograft in nude mice was demonstrated using a novel core/shell structure of Fe3O4@MoS2 nanocubes （IOMS NCs） via the integration of MoS2 （MS） film onto iron oxide （IO） nanocubes through a facile hydrothermal method. After the necessary PEGylation modification of the NCs for long-circulation purposes, such PEGylated NCs were further capped by 2-deoxy-D-glucose （2-DG）, a non-metabolizable glucose analogue to increase the accumulation of the as-prepared NCs at the tumor site, as 2-DG molecules could be particularly attractive to resource-hungry cancer cells. Such 2-DG- modified PEGylated NCs （IOMS-PEG-2DG NCs） acted as drug-carriers for doxorubicin （DOX）, which could be easily loaded within the NCs. The obtained IOMS-PEG（DOX）-2DG NCs exhibited a 3？2 relaxivity coefficient of 48.86 （mM）^-1·s^-1 and excellent photothermal performance. 24 h after intravenous injection of IOMS-PEG（DOX）-2DG NCs, the tumor site was clearly detected by enhanced T2-weighted MRI signal. Upon exposure to an NIR 808-nm laser for 5 rain at a low power density of 0.5 W·cm^-2 a marked temperature increase was noticed within the tumor site, and the tumor growth was efficiently inhibited by the chemo-photothermal effect. Therefore, our study highlights an excellent theranostic platform with great potential for targeted MRI-guided precise chemo-photothermal therapy of breast cancer.

Solid rocket motor propellant grain burnback simulation based on fast minimum distance function calculation and improved marching tetrahedron method

To efficiently compute arbitrary propellant grain evolution of the burning surface with uniform and non-uniform burning rate for solid rocket motor,a unified framework of burning surface regression simulation has been developed based on minimum distance function.In order to speed up the computation of the mini-mum distance between grid nodes of grain and the triangular mesh of burning surface,a fast distance querying method based on the equal size cube voxel structure was employed.An improved marching tetrahedron method based on piecewise linear approximation was carried out on second-order tetrahedral elements,achieved high-efficiency and adequate accuracy of burning surface extraction simultaneously.The cases of star grain,finocyl grain,and non-uniform tube grain were studied to verify the proposed method.The observed result indicates that the grain burnback computation method could realize the accurate simulation on unstructured tetrahedral mesh with a desirable performance on computational time.

OsMADS32 interacts with PI-like proteins and regulates rice flower development

OsMADS32 is a monocot specific MIKCc type MADS‐box gene that plays an important role in regulating rice floral meristem and organs identity, a crucial process for reproductive success and rice yield. However, its underlying mechanism of action remains to be clarified. Here, we characterized a hypomorphic mutant allele of OsMADS32/CFO1, cfo1‐3 and identified its function in controlling rice flower development by bioinformatics and protein‐protein interaction analysis. The cfo1‐3 mutant produces defective flowers, including loss of lodicule identity, formation of ectopic lodicule or hull‐like organs and decreased stamen number, mimicking phenotypes related to the mutation of B class genes. Molecular characterization indicated that mis‐splicing of OsMADS32 transcripts in the cfo1‐3 mutant resulted in an extra eight amino acids in the K‐domain of OsMADS32 protein. By yeast two hybrid and bimolecular fluorescence comple-mentation assays, we revealed that the insertion of eight amino acids or deletion of the internal region in the K1 subdomain of OsMADS32 affects the interaction between OsMADS32 with PISTILLATA （PI）‐like proteins OsMADS2 and OsMADS4. This work provides new insight into the mecha-nism by which OsMADS32 regulates rice lodicule and stamen identity, by interaction with two PI‐like proteins via its K domain.

A review of object representation based on local features

Object representation based on local features is a topical subject in the domain of image understanding and computer vision. We discuss the defects of global features in present methods and the advantages of local features in object recognition, and briefly explore state-of-the-art recognition methods using local features, especially the main approaches of local feature extraction and object representation. To clearly explain these methods, the problem of local feature extraction is divided into feature region detection, feature region description, and feature space optimization. The main components and merits of these steps are presented. Technologies for object presentation are classified into three types: vector space, sliding window, and structure relationship models. Future development trends are discussed briefly.

Ultrafast and real-time physical random bit extraction with all-optical quantization

Optical chaos generated by perturbing semiconductor lasers has been viewed,over recent decades,as an excellent entropy source for fast physical random bit generation(RBG)owing to its high bandwidth and large random fluctuations.However,most optical-chaos-based random bit generators perform their quantization process in the electrical domain using electrical analog-to-digital converters,so their real-time rates in a single channel are severely limited at the level of Gb/s due to the electronic bottleneck.Here,we propose and experimentally demonstrate an all-optical method for RBG where chaotic pulses are quantized into a physical random bit stream in the all-optical domain by means of a length of highly nonlinear fiber.In our proof-of-concept experiment,a 10-Gb/s random bit stream is successfully generated on-line using our method.Note that the single-channel real-time rate is limited only by the chaos bandwidth.Considering that the Kerr nonlinearity of silica fiber with an ultrafast response of few femtoseconds is exploited for composing the key part of quantizing laser chaos,this scheme thus may operate potentially at much higher real-time rates than 100 Gb/s provided that a chaotic entropy source of sufficient bandwidth is available.

Modulation format identification in fiber communications using single dynamical node-based photonic reservoir computing

We present a simple approach based on photonic reservoir computing(P-RC)for modulation format identification(MFI)in optical fiber communications.Here an optically injected semiconductor laser with self-delay feedback is trained with the representative features from the asynchronous amplitude histograms of modulation signals.Numerical simulations are conducted for three widely used modulation formats(on–off keying,differential phase-shift keying,and quadrature amplitude modulation)for various transmission situations where the optical signal-to-noise ratio varies from 12 to 26 d B,the chromatic dispersion varies from-500 to 500 ps/nm,and the differential group delay varies from 0 to 20 ps.Under these situations,final simulation results demonstrate that this technique can efficiently identify all those modulation formats with an accuracy of>95%after optimizing the control parameters of the P-RC layer such as the injection strength,feedback strength,bias current,and frequency detuning.The proposed technique utilizes very simple devices and thus offers a resource-efficient alternative approach to MFI.

The efficacy of rapid on-site evaluation during endoscopic ultrasound-guided fine needle aspiration of pancreatic masses

Background:Endoscopic ultrasound(EUS)-guided fine needle aspiration(FNA)has become the preferred method to diagnose pancreatic masses due to its minimally invasive approach and diagnostic accuracy.Many studies have shown that rapid on-site evaluation(ROSE)improves diagnostic yield by 10–30%;however,more recent studies have demonstrated effective diagnostic accuracy rates without ROSE.Our study aims to examine whether the current standard of performing ROSE after each FNA pass adds diagnostic value during EUS-guided FNA of pancreatic masses.Methods:We conducted a retrospective case series on patients who underwent EUS-guided FNA of pancreatic masses between February 2011 and October 2014.All cases were performed by one of three endoscopists at Emory University Hospital.Patient demographics,radiologic details of pancreatic masses and pathology reports of the biopsied pancreatic masses were examined.Results:A total of 184 procedures performed in 171 patients were reviewed.The final pathology reports of the biopsied pancreatic masses showed 128(70%)with confirmed malignancy.Only 64(50%)of these 128 cases initially showed malignant cells during ROSE.Among these 64 cases,23%required 5 or more FNA passes to first detect malignant cells.Conclusions:The use of ROSE during EUS-guided FNA of pancreatic masses may increase the diagnostic yield,since malignant cells were often detected during later FNA passes that would otherwise be missed if tissue sampling stopped prematurely.In addition,sample preparation for ROSE may be suboptimal,since malignant cells were only detected in 50%of cases.