Endothelin receptor antagonists for the treatment of diabetic nephropathy:A meta-analysis and systematic review

BACKGROUND Diabetic nephropathy(DN)is the main cause of chronic kidney disease and endstage renal disease worldwide.Although available clinical trials have shown that endothelin receptor(ER)antagonists may be a novel and beneficial drug for DN,no consistent conclusions regarding their sufficient effectiveness and safety for patients with DN have been presented.AIM To assess the effectiveness and safety of ER antagonists among patients with DN.METHODS The EMBASE,PubMed,MEDLINE,Cochrane,and ClinicalTrials.gov databases were searched without any language restrictions.Relative risks with 95%confidence intervals(CIs)for dichotomous data and mean differences or standardized mean difference with 95%CIs for continuous data were calculated using Review Manager 5.3 software.Publication bias was assessed using Egger’s test with Stata/SE software.RESULTS We enrolled seven studies with six data sets and 5271 participants.The ER antagonists group showed a significantly greater reduction in albuminuria and more patients with 40%reduction in urinary albumin-to-creatinine ratio than the control group(P<0.0001 and P=0.02,respectively).Subgroup analysis for reductions in estimated glomerular filtration rate(eGFR)showed that for the middle-dosage subgroup,the ER antagonists group exhibited lower eGFR reduction than the control group(P<0.00001;mean difference,0.7095%CI:0.66,0.74).Moreover,significant reductions in systolic and diastolic blood pressure were observed in the invention group.CONCLUSION ER blockades combined with angiotensin converting enzyme inhibitor/angiotensin II type 1 receptor blockers may be an effective treatment to lower blood pressure and reduce proteinuria in DN with declined eGFR.However,attention should be given to adverse events,including cardiac failure,anemia,and hypoglycemia,as well as serious adverse events.

Diagnostic value of ultrasound in the spontaneous rupture of renal angiomyolipoma during pregnancy:A case report

BACKGROUND Spontaneous rupture and hemorrhage of renal angiomyolipoma(RAML)is a lifethreatening clinical emergency.When it occurs during pregnancy,it is compared to a"bomb explosion,"which makes the diagnosis and treatment more challenging.An ultrasound examination is a quick and safe examination with the benefit of no radiation exposure,which is always preferred for pregnant women.Currently,cases of spontaneous rupture and hemorrhage of RAML during pregnancy are rare,as is the diagnostic value and characteristics of ultrasound.The lack of understanding of the condition among ultrasound doctors makes it prone to misdiagnosis.In this study,we present the case of a pregnant woman who was preliminarily diagnosed with spontaneous rupture and hemorrhage of the left RAML using ultrasound and discuss the ultrasound characteristics.CASE SUMMARY A 38-year-old woman in her 19 th wk of pregnancy(G2 P1)was referred to our clinic for a sudden,persistent pain on the left side of the waist.She had not undergone any previous related abdominal examination.Ultrasound of the urinary system revealed a giant nonhomogenous lump in the left kidney area.The diagnosis was considered spontaneous rupture and hemorrhage of the left RAML in pregnancy via ultrasound.Her left-side waist pain continued to be intense.Subsequently,she underwent computed tomography,which led to the same diagnosis.Based on many factors,the patient underwent left nephrectomy after the induction of labor.The pathological result was the rupture and hemorrhage of a vascular leiomyoma lipoma.CONCLUSION Ultrasound examination plays an important role in the diagnosis of the spontaneous rupture and hemorrhage of RAML during pregnancy.

Thyroid metastasis from breast cancer presenting with enlarged lateral cervical lymph nodes: A case report

BACKGROUND Secondary malignancy of the thyroid occurs infrequently and mainly originates from malignant tumors of the kidney,gastrointestinal tract,lungs,breast,and skin.The correct diagnosis is important but difficult.Importantly,there are major differences in the treatment of primary and metastatic thyroid cancer,which has a significant impact on prognosis and survival.Therefore,how to diagnose thyroid metastasis(TM)correctly before surgery is a major concern for surgeons.CASE SUMMARY We report a 38-year-old woman who presented with palpable cervical lymph nodes after breast cancer(BC)surgery 2 years ago.Ultrasonography and computed tomography revealed thyroid nodules with irregular margins and enlarged cervical lymph nodes.Biopsy was performed for the right largest cervical lymph node,and immunohistochemical analysis revealed negativity for thyroglobulin,estrogen receptor,and progestin receptor and positive for human epidermal growth factor receptor 2.The diagnosis was TM from BC with cervical lymph node metastasis.Total thyroidectomy with bilateral central and lateral neck lymph node dissection was performed.After a 5-mo follow-up,no recurrence or novel distant metastasis was identified.CONCLUSION TM from BC is a rare secondary malignancy.Broad differential diagnosis by biopsy and immunohistochemical analysis needs to be considered.

Gastric submucosal lesion caused by an embedded fish bone:A case report

BACKGROUND Submucosal tumors(SMTs)refer to elevated lesions that originate from the layers below the mucosa of the digestive tract,including the muscularis,submucosa and muscularis propria.With the development and application of endoscopy and endoscopic ultrasonography(EUS),the detection rate of SMTs has increased significantly in recent years.Various diseases can lead to SMTs.However,a foreign body embedded in the gastric antrum showing clinical manifestations of a SMT is rare.CASE SUMMARY We report the case of a 47-year-old woman,who presented with upper abdominal discomfort for one year,and was subsequently diagnosed with a gastric submucosal lesion caused by an embedded foreign body by EUS and computed tomography.Considering the size and potential complications of this lesion,endoscopic full-thickness resection was performed to achieve full resection in our endoscopy center.A fish bone was found in the lesion during the operation,and was successfully removed,and the defect was later closed with endoscopic pursestring sutures.CONCLUSION This case report highlights the management strategies of SMTs,the importance of being familiar with diagnostic methods related to submucosal lesions,and being able to conduct effective treatment when this rare condition is highly suspected.

大黄牡丹汤、透脓散加减联合抗生素治疗急性化脓性阑尾炎的体会

化脓性阑尾炎属于外科急腹症常见病证,根据其临床表现,中医辨病属于肠痈,而其辨证多与热、瘀有关,通腑泻热是其治疗的关键.中医根据其临床特点辨证论治,能够取得一定临床疗效.现简单介绍一下中医对化脓性阑尾炎的认识和治疗.

Preparation of La0.67Ca0.23Sr0.1MnO3 thin films with interesting electrical and magnetic properties via pulsed-laser deposition

Manganese oxides with a perovskite-type Re_(1-x)D_xMnO_3(Re:heavy rare-earth elements,D:divalent alkali metal)structure have attracted interest because of the complex interaction between their electrons,lattices,and spins[1-5].Generally,manganese oxides with the structure Re_(1-x)D_xMnO_3 have special properties.For example,the half-metallic manganites,such as La_(2/3)Sr_(1/3)MnO_3 and La_(2/3)Ca_(1/3)MnO_3,wherein the conduction electrons are completely spin polarized。

Three-dimensional electrical resistivity structure beneath the Cuonadong dome in the Northern Himalayas revealed by magnetotelluric data and its implication

The North Himalayan gneiss domes(NHGD),as one of the extensional structures widely distributed across the southern Tibetan Plateau,are an important window for studying post-collisional diastrophism and magmation as well as polymetallic mineralization.However,the deep mechanism for the formation of NHGD remains controversial.The magnetotelluric(MT)method was adopted to study the deep structure of the Cuonadong dome in the Northern Himalayas.The characteristics of the dome were explored by using the MT sounding curves and phase tensors.Three-dimensional(3D)MT inversion was performed to determine the electrical resistivity structure beneath the Cuonadong dome.The preferred 3D electrical resistivity model shows that an obvious low-resistivity anomaly develops beneath the Cuonadong dome which is overlaid by a high-resistivity body and surrounded by an apparent subcircular zone of low-resistivity anomalies.The integrated conductivity(longitudinal conductance)from depths of 1-20 km indicates that the average longitudinal conductance at the core of the Cuonadong dome is about 10,000 S.The high-conductivity anomaly at the core is found to be analogous to that of lava,mainly resulting from the crustal partial melting,and the estimated melt content is 11.0-17.3%.The high conductance surrounding the dome reaches 20,000 S on average,which is mainly attributed to saline fluids.MT results in this study support that the Cuonadong dome experienced magmatic diapirism.Taken together with previous geological and geochemical studies,we suggest that under the east-west(E-W)extensional tectonic setting in southern Tibet,deep crustal partial melting constantly accumulated beneath the dome,and therefore the magmatic diapirism resulted in the formation of the Cuonadong dome.In addition,the MT results also indicate that the development of the Cuonadong dome provides abundant mineralizing fluids and the space for migration of metallogenic fluids for(rare-metal)polymetallic mineralization.

Improvement of tensile superelasticity by aging treatment of NiTi shape memory alloys fabricated by electron beam wire-feed additive manufacturing

For the first time,this work comprehensively studied the effectiveness of precipitation hardening achieved by aging treatment in improving the tensile superelasticity of NiTi alloys fabricated by elec-tron beam wire-feed additive manufacturing(EBAM),which possesses inherent advantages in producing dense and oxidation-free structures.Aging treatments under three temperatures(450,350,and 250℃)and different durations were conducted,and the resultant performance of tensile superelasticity,together with the corresponding evolution of precipitation and phase transformation behavior were investigated for the EBAM-fabricated NiTi alloys.Results showed that by appropriate aging treatment,EBAM fabricated NiTi alloys could achieve excellent recovery rates of approximately 95%and 90%after the 1st and 10th load/unload cycle for a maximum tensile strain of 6%,which were almost the highest achieved so far by AM processed NiTi alloys and close to those of some conventional NiTi alloys.The improvement of tensile superelasticity benefited from the fine and dispersive Ni4Ti3 precipitates,which could be introduced by aging at 350℃ for 4 h or at 250℃ for 200 h.Moreover,the large amount of Ni4Ti3 precipitates would promote the intermediate R-phase transformation and bring a two-stage or three-stage transformation sequence,which depended on whether the distribution of the precipitation was homogeneous or not.This work could provide guidance for the production of NiTi alloys with good tensile superelasticity by EBAM or other additive manufacturing processes.

Kronos:towards bus contention-aware job scheduling in warehouse scale computers

While researchers have proposed many techniques to mitigate the contention on the shared cache and memory bandwidth, none of them has considered the memory bus contention due to split lock. Our study shows that the split lock may cause 9X longer data access latency without saturating the memory bandwidth. To minimize the impact of split lock, we propose Kronos, a runtime system composed of an online bus contention tolerance meter and a bus contention-aware job scheduler. The meter characterizes the tolerance of jobs to the “pressure” of bus contention and builds a tolerance model with the polynomial regression technique. The job scheduler allocates user jobs to the physical nodes in a contention aware manner. We design three scheduling policies that minimize the number of required nodes while ensuring the Service Level Agreement (SLA) of all the user jobs, minimize the number of jobs that suffer from SLA violation without enough nodes, and maximize the overall performance without considering the SLA violation, respectively. Adopting the three policies, Kronos reduces the number of the required nodes by 42.1% while ensuring the SLA of all the jobs, reduces the number of the jobs that suffer from SLA violation without enough nodes by 72.8%, and improves the overall performance by 35.2% without considering SLA.

Photocatalytic reduction of Cr(Ⅵ)by WO_(3)@PVP with elevated conduction band level and improved charge carrier separation property

Photocatalytic reduction of heavy metal ions is a green and promising technology which requires electrons with enough negative energy levels as well as efficient separation property from photo-generated holes of photocatalysts.For WO_(3),the low conduction band edge and the severe photo-generated charge carrier recombination limited its application in photocatalytic reduction of pollutants.In this work,we prepared WO_(3)@PVP with PVP capped WO_(3) by a simple one-step hydrothermal method,which showed an elevated energy band structure and improved charge carrier separation property.XRD,SEM,TEM,XPS,DRS,and the photocurrent density test were carried out to study the properties of the composite.Results demonstrated monoclinic WO_(3) with a size of~100-250 nm capped by PVP was obtained,which possessed fewer lattice defects inside but more defects(W^(5+))on the surface.Moreover,the results of the photocatalytic experiment showed the kinetic constant of Cr(Ⅵ)reduction process on WO_(3)@PVP was 0.532 h^(-1),which was 3.1 times higher than that onWO_(3)(0.174 h^(-1)),demonstratingWO_(3)@PVP with good photocatalytic capability for Cr(Ⅵ)reduction.This can be attributed to the improved charge carrier separation performance,the improved adsorption capacity and the elevated conduction band edge of WO_(3)@PVP.More importantly,the energy band structure of WO_(3)@PVP was proved elevated with a value as high as 1.14 eV than that of WO_(3) nanoparticles,which enables WO_(3)@PVP a promising material in the photocatalytic reduction reaction of heavy metal ions from wastewater.