Isolated axillary tumor deposit consistent with primary breast carcinoma:A case report

BACKGROUND We all know that lymph-node metastasis is an important factor for poor clinical outcome in breast cancer prognosis.Tumor deposit refers to a discrete collection of cancer cells that is found in the lymph nodes or other tissues adjacent to the primary tumor site.These tumor deposits are separate from the primary tumor and are often considered as a manifestation of lymph node metastasis.In gastric and colorectal cancer,tumor deposits in the lymph node drainage area have been included as independent prognostic factors.The question arises whether tumor deposits should also be considered as prognostic factors in breast cancer patients.This article aims to provoke some thoughts on this matter through a case study and literature review.CASE SUMMARY A 70-year-old female patient was found to have a right breast lump for over 2 years.On January 3,2023,a core needle biopsy of the right breast lump was performed,and the pathology report indicated invasive carcinoma.Subsequently,on January 17,2023,the patient underwent right breast-conserving surgery,sentinel lymph node biopsy,and right axillary lymph node dissection.The postoperative pathological staging was determined as stage IIB.The patient received chemotherapy,radiotherapy,and endocrine therapy.At present,nearly one year after the surgery,no obvious signs of metastasis have been observed in the follow-up examinations,but the long-term prognosis is still unknown.CONCLUSION There is a need for increased focus on the matter of tumor deposits in the lymph node drainage region,as well as a requirement for further clinical investigation to ascertain the relevance of tumor deposits in the prognosis of individuals with breast carcinoma.

Altered amplitude of low-frequency fluctuations and default mode network connectivity in high myopia:a resting-state fMRI study

AIM:To analyze changes in amplitude of low-frequency fluctuations(ALFFs)and default mode network(DMN)connectivity in the brain,using resting-state functional magnetic resonance imaging(rs-fMRI),in high myopia(HM)patients.METHODS:Eleven patients with HM(HM group)and 15 age-and sex-matched non-HM controls(non-HM group)were recruited.ALFFs were calculated and compared between HM group and non-HM group.Independent component analysis(ICA)was conducted to identify DMN,and comparisons between DMNs of two groups were performed.Region-of-interest(ROI)-based analysis was performed to explore functional connectivity(FC)between DMN regions.RESULTS:Significantly increased ALFFs in left inferior temporal gyrus(ITG),bilateral rectus gyrus(REC),bilateral middle temporal gyrus(MTG),left superior temporal gyrus(STG),and left angular gyrus(ANG)were detected in HM group compared with non-HM group(all P<0.01).HM group showed increased FC in the posterior cingulate gyrus(PCC)/precuneus(preCUN)and decreased FC in the left medial prefrontal cortex(mPFG)within DMN compared with nonHM group(all P<0.01).Compared with non-HM group,HM group showed higher FC between mPFG and bilateral middle frontal gyrus(MFG),ANG,and MTG(all P<0.01).In addition,HM patients showed higher FC between PCC/(preCUN)and the right cerebellum,superior frontal gyrus(SFG),left pre CUN,superior frontal gyrus(SFG),and medial orbital of the superior frontal gyrus(ORB supmed;all P<0.01).CONCLUSION:HM patients show different ALFFs and DMNs compared with non-HM subjects,which may imply the cognitive alterations related to HM.

Positive Rate of Different Hepatitis B Virus Serological Markers in Peking Union Medical College Hospital,a General Tertiary Hospital in Beijing

Objectives To investigate the positive rate of different hepatitis B virus(HBV) serological markers,and the demographic factors related to HBV infection.Methods We enrolled all patients tested for HBV serological markers,such as HBV surface antigen(HBsAg),HBV surface antibody(HBsAb),hepatitis B e antigen(HBeAg),hepatitis B e antibody(HBeAb),HBV core antibody(HBcAb),and HBV-DNA from July 2008 to July 2009 in Peking Union Medical College Hospital.The positive rate of each HBV serological marker was calculated according to gender,age,and department,respectively.The positive rates of HBV-DNA among patients with positive HBsAg were also analyzed.Results Among 27 409 samples included,2681(9.8%) were HBsAg positive.When patients were divided into 9 age groups,the age-specific positive rate of HBsAg was 1.2%,9.6%,12.3%,10.9%,10.3%,9.7%,8.0%,S.8%,and 4.3%,respectively.The positive rate of HBsAg in non-surgical department,surgical department,and health examination center was 16.2%,5.8%> and 4.7%,respectively.The positive rate of HBsAg of males(13.3%) was higher than that of females(7.3%,P=0.000).Among the 2681 HBsAg(+)patients,1230(45.9%) had HBV-DNA test,of whom 564(45.9%) were positive.Patients with HBsAg(+),HBeAg(+),and HBcAg(+) result usually had high positive rate of HBV-DNA results(71.8%,P=0.000).Conclusions Among this group of patients in our hospital,the positive rate of HBsAg was relatively high.Age group of 20-29,males,and patients in non-surgical departments were factors associated with high positive rate of HBsAg.

A biarc-based shape optimization approach to reduce stress concentration effects

In order to avoid stress concentration, the shape boundary must be properly designed via shape optimiza- tion. Traditional shape optimization approach eliminates the stress concentration effect by using free-form curve to present the design boundaries without taking the machin- ability into consideration. In most numerical control （NC） machines, linear as well as circular interpolations are used to generate the tool path. Non-circular curves, such as non- uniform rotational B-spline （NURBS）, need other more ad- vanced interpolation functions to formulate the tool path. Forming the circular tool path by approximating the opti- mal free curve boundary with arcs or biarcs is another op- tion. However, these two approaches are both at a cost of sharp expansion of program code and long machining time consequently. Motivated by the success of recent researches on biarcs, a reliable shape optimization approach is pro- posed in this work to directly optimize the shape boundaries with biarcs while the efficiency and precision of traditional method are preserved. Finally, the approach is validated by several illustrative examples.

Shape optimization of axisymmetric solids with the finite cell method using a fixed grid

In this work, a design procedure extending the B-spline based finite cell method into shape optimization is developed for axisymmetric solids involving the centrifugal force effect. We first replace the traditional conforming mesh in the finite element method with structured cells that are fixed during the whole design process with a view to avoid the sophisticated re-meshing and eventual mesh distortion.Then, B-spline shape functions are further implemented to yield a high-order continuity field along the cell boundary in stress analysis. By means of the implicit description of the shape boundary, stress sensitivity is analytically derived with respect to shape design variables. Finally, we illustrate the efficiency and accuracy of the proposed protocol by several numerical test cases as well as a whole design procedure carried out on an aeronautic turbine disk.

Binocular vision and abnormal head posture in children when watching television

AIM： To determine the association between the binocular vision and an abnormal head posture（AHP）when watching television（TV） in children 7-14 y of age.·METHODS： Fifty normal children in the normal group and 52 children with an AHP when watching TV in the AHP group were tested for spherical equivalents, far and near fusional convergence（FC） and fusional divergence（FD） amplitudes, near point of convergence, far and near heterophoria, accommodative convergence/accommodation ratio and stereoacuity. The values of these tests were compared between the two groups. The independent t test was applied at a confidence level of95%.·RESULTS： The far and near FC amplitudes and far FD amplitudes were lower in the AHP group（the far FC amplitudes： break point 13.6±5.4~△, recovery point 8.7±5.4~△.The near FC amplitudes： break point 14.5 ±7.3~△, recovery point 10. 3 ± 5. 1~△. The far FD amplitudes ： break point3.9±2.7~△, recovery point 2.6±2.3~△） compared with those in the normal group（the far FC amplitudes： break point19.1 ±6.2△, recovery point 12.4 ±4.5~△. The near FC amplitudes： break point 22.3 ±8.0~△, recovery point 16.1 ±5.7~△. The far FD amplitudes： break point 7.0 ±2.1~△,recovery point 4.6 ±1.9~△）. Other tests presented no statistically significant differences.·CONCLUSION： An association between the reduced FC and FD amplitudes and the AHP in children when watching TV is proposed in the study. This kind of AHP is considered to be an anomalous manifestation which appears in a part of puerile patients of fusional vergence dysfunction.

Investigation of Hepatitis C Virus Infection Rate of Patients in a General Hospital

Objective To investigate the infection rate of hepatitis C virus among the ambulatory patients and in-patients of a tertiary teaching hospital,and study the demographic factors related to the prevalence of hepatitis C virus infection.Methods All patients tested for hepatitis C virus antibody from July 2008 to July 2009 in Peking Union Medical College Hospital were enrolled in this cross-sectional analysis.The prevalence of hepatitis C virus infection was compared according to age,gender,and departments,respectively.Among patients with positive serology hepatitis C virus marker,the positivity of hepatitis C virus RNA was analysed.Results Among 29 896 subjects included,the hepatitis C virus antibody of 494 patients were positive(1.7%).When patients were divided into 9 age groups,the age specific prevalence of hepatitis C virus antibody were0.2%,1.7%,1.2%,1.1%,1.5%,1.9%,2.6%,2.4%and 2%,respectively.The prevalence of hepatitis C virus antibody in non-surgical department and surgical department was 3%and 1%,respectively.The prevalence of hepatitis C virus antibody of males was higher than that of the females.Total of 194 patients with positive hepatitis C virus antibody were tested for hepatitis C virus RNA,the RNA level of 113 patients(58.2%)were higher than the low detection limit.Conclusions The prevalence of hepatitis C virus antibody was relatively high among patients of general tertiary hospital.Age group of 60-69,males and patients in non-surgical departments were factors associated with high rate of hepatitis C virus infection.

XELOX(capecitabine plus oxaliplatin)plus bevacizumab(anti-VEGF-A antibody)with or without adoptive cell immunotherapy in the treatment of patients with previously untreated metastatic colorectal cancer:a multicenter,open-label,randomized,controlled,phase 3 trial

Fluoropyrimidine-based combination chemotherapy plus targeted therapy is the standard initial treatment for unresectable metastatic colorectal cancer(mCRC),but the prognosis remains poor.This phase 3 trial(ClinicalTrials.gov:NCT03950154)assessed the efficacy and adverse events(AEs)of the combination of PD-1 blockade-activated DC-CIK(PD1-T)cells with XELOX plus bevacizumab as a first-line therapy in patients with mCRC.A total of 202 participants were enrolled and randomly assigned in a 1:1 ratio to receive either first-line XELOX plus bevacizumab(the control group,n=102)or the same regimen plus autologous PD1-T cell immunotherapy(the immunotherapy group,n=100)every 21 days for up to 6 cycles,followed by maintenance treatment with capecitabine and bevacizumab.The main endpoint of the trial was progression-free survival(PFS).The median follow-up was 19.5 months.Median PFS was 14.8 months(95%CI,11.6-18.0)for the immunotherapy group compared with 9.9 months(8.0-11.8)for the control group(hazard ratio[HR],0.60[95%CI,0.40-0.88];p=0.009).Median overall survival(OS)was not reached for the immunotherapy group and 25.6 months(95%CI,18.3-32.8)for the control group(HR,0.57[95%CI,0.33-0.98];p=0.043).Grade 3 or higher AEs occurred in 20.0%of patients in the immunotherapy group and 23.5%in the control groups,with no toxicity-associated deaths reported.The addition of PD1-T cells to first-line XELOX plus bevacizumab demonstrates significant clinical improvement of PFS and OS with well tolerability in patients with previously untreated mCRC.

A new error-controllable method for smoothing the G01 commands

In real machining, the tool paths are composed of a series of short line segments, which constitute groups of sharp corners correspondingly leading to geometry discontinuity in tangent. As a result, high acceleration with high fluctuation usually occurs. If these kinds of tool paths are directly used for machining, the feedrate and quality will be greatly reduced. Thus, generating continuous tool paths is strongly desired. This paper presents a new error-controllable method for generating continuous tool path. Different from the traditional method focusing on fitting the cutter locations, the proposed method realizes globally smoothing the tool path in an error-controllable way. Concretely, it does the smoothing by approaching the newly produced curve to the linear tool path by taking the tolerance requirement as a constraint. That is, the error between the desired tool path and the G01 commands are taken as a boundary condition to ensure the finally smoothed curve being within the given tolerance. Besides, to improve the smoothing ability in case of small corner angle, an improved local smoothing method is also proposed by symmetrically assigning the control points to the two adjacent linear segments with the constrains of tolerance and G3 continuity. Experiments on an open five-axis machine are developed to verify the advantages of the proposed methods.

Investigation of Work Hardening Behavior of Inconel X-750 Alloy

The constant strain rate uniaxial compression tests were conducted in this paper for studying the work hardening behavior and revealing the underlying microstructure evolution involved in the plastic response of the nickel-based Inconel X-750 alloy. The work hardening rate versus true strain plots of Inconel X-750 alloy resembled that of low-stacking-fault energy （SFE） alloys with distinct four stages. The dislocations were found in the planar arrangements at a strain of 0.1 located at the onset of stage II, and the dislocation density was increased and the planar arrangement configuration was partially destroyed at a strain of 0.36 located in stage III. It was unexpected that deformation twins were observed at a strain of 0.69 located in stage IV although the alloy has been classified into materials with a higher SFE value. The result is different with a similar study, in which the deformation twins were absent in Ni-Cr-based alloy Inconel 625 even when the strain was as high as 0.65. It was deemed that the low level of solution strengthening favored the deformation of matrix and the activation of slip system for twining in Inconel X-750 alloy. Unlike the low-SFE alloys that the twins were always formed at the end of stage Ⅰ, the higher SFE delayed the twin formation to stage IV for Inconel X-750 alloy. The well- developed planar dislocation configuration gave rise to the stage Ⅱ with a slightly decreasing rate, the collapse of planar dislocation arrangements caused the occurrence of stage Ⅲ with an accelerated decreasing rate, and the twin formation led to the stage IV with a nearly constant work hardening rate.

Proteins as functional interlayer in organic field-effect transistor

The paper summarizes and discusses the recent advances of proteins as functional interlayers in organic field-effect transistors（OFETs）.Specific focus is given on the proteins integrated into the device structure,either to act as dielectric materials or to perform as the functional interlayer between the dielectric and the organic semiconductor（OSC）.The main emphasis is give to the location and the specific effect of protein layers in the structure of OFETs.Besides,the possibility of amyloid serving as useful building blocks for OFET is discussed.

Two new species of the genus Boysidia from China, with a preliminary discussion of its geography (Pulmonata: Stylommatophora: Pupillidae)

Two species of the genus Boysidia Ancey, 1881 were reported as new to science, Boysidia（Boysidia） xianfengensis sp. nov. and B.（B.） xiaoguanensis sp. nov., while the distribution of the 23 species of Boysidia from China was discussed. The materials of the new species were collected from Hubei Province, China by authors. The shell of B.（B.） xianfengensis sp. nov. looks small（height 4.90 mm, diameter 3.10 mm）, and has five apertural teeth： one large parietal tooth, one long columellar tooth, one small nipple-shaped upper palatal tooth, one large flake-shaped lower palatal tooth, one small infrapalatal tooth. The shell of B.（B.） xiaoguanensis sp. nov. looks small（height 3.55 mm, diameter 2.20 mm）, and has four apertural teeth： one large parietal tooth, one long columellar tooth, one large flake-shaped upper palatal tooth, one slightly small flake-shaped lower palatal tooth. The type specimens of the new species are deposited in the Institute of Zoology, Chinese Academy of Sciences, China.

Determination of optimal geometrical parameters of peripheral mills to achieve good process stability

This paper focuses on optimization of the geo-metrical parameters of peripheral milling tools by takinginto account the dynamic effect. A substructure synthesistechnique is used to calculate the frequency responsefunction of the tool point, which is adopted to determinethe stability lobe diagram. Based on the Taguchi designmethod, simulations are first conducted for varying com-binations of tool overhang length, helix angle, and teethnumber. The optimal geometrical parameters of the tool aredetermined through an orthogonal analysis of the maxi-mum axial depth of cut, which is obtained from the pre-dicted stability lobe diagram. It was found that thesequence of every factor used to determine the optimal toolgeometrical parameters was the tool overhang length, teethnumber, and helix angle. Finally, a series of experimentswere carried out as a parameter study to determine theinfluence of the tool overhang length, helix angle, and teethnumber on the cutting stability of a mill. The same con-clusion as that obtained through the simulation wasobserved.

Older European Adults and Access to Healthcare During the COVID-19 Pandemic

In Europe,population ageing poses a challenge.Given accelerating population ageing in Europe,longterm care(LTC)is a growing concern.Unmet healthcare needs varied among European countries during the coronavirus disease 2019(COVID-19)pandemic,and greater attention should be paid to ensuring that the healthcare needs of vulnerable populations are met.Notably,developing common and comparable indicators is useful for monitoring the LTC and healthcare of older adults at the national and international levels,and understanding the reasons for the differences in indicators between European countries could shed light on how to improve the health of older adults.

Distribution of Phosphorus and Its Effects on Precipitation Behaviors and Tensile Properties of IN718C Cast Superalloy

The effect of phosphorus on the precipitations of γ″,γ' and 8 phases and associated tensile properties in IN718C alloy are investigated in this study. It is revealed that P atoms are dissolved in the grain interior to a relatively high degree and hence influence the precipitation behaviors in the grain interior and improve the tensile strength of IN718C alloy.γ″ and γ' phases did not precipitate in the alloy without P addition during air cooling, while γ″ and phases precipitated in the grain interior during air cooling in the alloys with P addition, and the amounts of γ″ and γ' phases increased with increasing P content. Therefore, the Vickers micro-hardness in the as-cast state increased gradually with increasing P content. In double-aging state, the sizes of γ″ and γ' phases in the alloys with P addition were larger than that in the alloy without P addition, while the sizes were invariable when the P content (wt%) was higher than 0.015. Therefore, the micro-hardness and tensile strength of IN718C alloy treated by double aging increased first and then kept invariable with increasing P content. The precipitations of 8 phases both in the grain interior and on grain boundaries were inhibited by P markedly. The inhibitory effect of P on 8 phase enhanced gradually with increasing content of P, but the plasticity increased first and then decreased. What is more, the crack tended to propagate into the matrix around the particles (Laves phases and NbC carbides) in the alloys without P addition at the beginning of the tensile fracture, while it tended to propagate along the interfaces between the matrix and those particles in the alloys with P addition, which resulted from the synthetical effect of P on γ″,γ' and 8 phases.

Re-recognition of the Effects of Phosphorus and Boron on the γ’’ and γ’ Phases in IN718 Alloy

The effects of P and B on the matrix strength and precipitations of γ’ and γ’’ phases in the grain interior were re-recognized in this study. The combination addition of P and B markedly accelerated the precipitations of γ’ and γ’’ phases and strengthened the matrix of IN718 alloy when air-cooled from high temperature, while made no difference when waterquenched from high temperature. The effect of single addition of P on the precipitations of γ’’ and γ’ phases was the same with that of the combination addition of P and B, while the single addition of B had no effect on the precipitations of the two phases. Therefore, it was P rather than B which accelerated the precipitations of γ’ and γ’’ phases. P could take part in the precipitations of γ’ and γ’’ phases, which was revealed by electrochemical extraction and quantitative analysis of chemical composition. It also revealed that P atoms were dissolved in the c matrix to a relatively high degree at the temperature that γ’ and γ’’ phases began to precipitate, and consequently the precipitations of γ’ and γ’’ phases were accelerated. The first-principle calculation indicated that P decreased the formation enthalpies of γ’ and γ’’ phases when it occupied the Ni lattice sites in the two phases, which explained the effect of P on the γ’ and γ’’ phases.

Systematic review of experiences and effects of integrating post-abortion family planning services into existing health system worldwide

Objective To systematic review and analyze the practices and effects of integrating post-abortion family planning （PAFP） services into existing health system worldwide in order to inform the future interventions to deliver PAFP in China. Methods A systematic search for relevant published and unpublished literature was conducted. Based on a set of criteria, citation and full text were screened, related data were extracted. Findings of included studies were reviewed and analyzed using a textual narrative approach to synthesis. Results A total of 28 studies were included in the synthesis. The studies were published between 1995 and 2008 and covered 20 countries. Some countries were in the stage of piloting post-abortion care （PAC）/PAFP intervention, while others were either from piloting to scaling up or examined how well a pilot PAC/PAFP intervention and resulting improvements were able to be maintained over the long term in the same intervention site. Most studies examined initiatives that were implemented at public sectors from tertiary, secondary to primary health facilities, while a few were imple- mented at private sectors. Efforts of integrating PAFP into existing health system from health system perspectives such as funding the programs, training of trainer （TOT） training or on the job training of physicians and mid-level service provider, expan- sion the range of contraceptive methods available including a few free distribution of contraceptives, improving data collection including cost analysis in a few countries,service guidelines provided to health professionals, supportive supervision at program sites to ensure quality of care, and leadership from government to strengthen PAC/ PAFP service by revising or developing a new national policy. Effects of those intervention programs included that 2 studies decreased abortion rates, 7 studies improved modern contraceptive use, 1 study improved women＇s knowledge on sexual ＆ reproductive health, and 5 studies reported women＇s high satisfaction rate with receiving PAC/PAFP services. Conclusion Each study was conducted within a cultural legal social and religious framework. There might be no single set of best practices that can be put forward as a model to integrate PAFP into existing health system in China. These areas should be taken into account in our future intervention including government＇s optimization and complement to the regulations related to abortion, contraception and PAFP, capacity building for service provider, continuous efforts to improve the quality of PAFP service, and accessibility of multiple contraceptive methods for married as well as unmarried youth.

Mifepristone in Combination with Misoprostol for the Termination of Pregnancy at 8-16 Weeks' Gestational Age: A Multicentre Randomized Controlled Trial

Objective To compare the efficacy and safety of medical abortion of different regimens for termination of pregnancy at 8-16 weeks of gestation. Methods Healthy pregnant women requesting medical abortion at 8-16 weeks＇ gestation within 12 hospitals in Shanghai were randomly allocated to four treatment groups. Three intervention groups were given mifepristone 200 mg as a single dose then 24 h later misoprostol 600 #g at 3 h intervals vaginally, orally or vaginally followed by orally, respectively. Control group was given mifepristone 100 mg for 2 d, followed at 48 h by initiation of misoprostol 600 μg vaginally every 12 h. The primary outcome measures were the successful abortion rate, the induction-to-abortion interval, vaginal bleeding and side effects. Results Efficacy outcomes were analyzed for 1 112 women （92.67%）, excluding 88 protocol violations. Termination successful rates were similar among the four groups from 97.1% to 97.8%. The average dose of misoprostol and the incidence of side effects in control group were lower than those in three intervention groups. Stratified analysis showed that the interval of induction-to-abortion at gestation of 1116 weeks was decreased in control group. Conclusion The four regimens have the similar termination successful rates in spite of different administration intervals or routes. Control group was recommended for the advantages of reduced dose of misoprostol and fewer side effects.