Myeloperoxidase-antineutrophil cytoplasmic antibody-associated vasculitis with headache and kidney involvement at presentation and with arthralgia at relapse:A case report

BACKGROUND Patients with proteinase 3-antineutrophil cytoplasmic antibody associated vasculitis(AAV)experience different manifestations at the initial onset and relapse.However,such cases of different initial and relapse manifestations have not been reported in myeloperoxidase(MPO)-AAV patients.CASE SUMMARY A 52-year-old woman was admitted to our hospital because of headache.Laboratory findings indicated nephrotic range proteinuria and microscopic hematuria,serum creatinine of 243μmol/L,anti-MPO antibody titer of>400 RU/mL,and positive perinuclearantineutrophil cytoplasmic antibody.Renal biopsy showed pauci-immune crescentic glomerulonephritis.The cerebrospinal fluid examination and brain magnetic resonance imaging did not show any abnormality.Therefore,MPO-AAV was diagnosed.Corticosteroids,plasmapheresis,and cyclophosphamide as induction therapy and mycophenolate mofetil(MMF)as maintenance therapy were administered.The patient’s headache disappeared;serum creatinine returned to normal;complete remission of microscopic hematuria and proteinuria was observed.Anti-MPO antibody titer reached normal limits after immunosuppressive treatment.Twenty-five months after stopping the immunosuppressive treatment,the patient relapsed with arthralgia,without neurological or renal involvement.The patient’s arthralgia improved after treatment with prednisone and MMF.CONCLUSION We have reported a rare case of MPO-AAV who initially presented with headache and kidney involvement.However,relapse presented with only arthralgia,which was completely different from the initial manifestations.This case suggests that AAV relapse should be highly suspected in MPO-AAV patients after remission,when clinical manifestations at relapse are different from those at onset.Prednisone and MMF may provide a good choice for refractory arthralgia during relapse in MPO-AAV patients.

双镜联合技术在输尿管下段狭窄及损伤中的应用

目的探讨腹腔镜输尿管镜双镜联合技术治疗输尿管下段狭窄及损伤的可行性及临床疗效。方法对2016年1月-2017年9月该院应用双镜联合技术治疗的18例输尿管下段狭窄及损伤患者的临床资料进行回顾性分析,总结术中情况及手术经验。结果 18例手术均顺利完成,手术时间(172.7±22.5)min,术中出血(132.8±53.1)ml,术后肠蠕动功能恢复时间(1.6±0.4)d,术后下床活动时间(1.4±0.5)d,术后住院时间(7.1±1.7)d。所有患者平均随访(14.3±4.9)个月,无并发症,无输尿管再次狭窄。结论双镜联合技术可实现输尿管狭窄段/损伤段精确定位及准确切除,并实现输尿管原位吻合,没有解剖学结构改变,是一种安全可行、对机体创伤小且术后康复快的微创治疗方法,值得推广。

Low central venous pressure reduces blood loss in hepatectomy

AIM： To investigate the effect of low central venous pressure （LCVP） on blood loss during hepatectomy for hepatocellular carcinoma （HCC）. METHODS： By the method of sealed envelope, 50 HCC patients were randomized into LCVP group （n=25） and control group （n=25）. In LCVP group, CVP was maintained at 2-4 mmHg and systolic blood pressure （SBP） above 90 mmHg by manipulation of the patient＇s posture and administration of drugs during hepatectomy, while in control group hepatectomy was performed routinely without lowering CVP. The patients＇ preoperative conditions, volume of blood loss during hepatectomy, volume of blood transfusion, length of hospital stay, changes in hepatic and renal functions were compared between the two groups. RESULTS： There were no significant differences in patients＇ preoperative conditions, maximal tumor dimension, pattern of hepatectomy, duration of vascular occlusion, operation time, weight of resected liver tissues, incidence of post-operative complications, hepatic and renal functions between the two groups. LCVP group had a markedly lower volume of total intraoperative blood loss and blood loss during hepatectomy than the control group, being 903.9 ± 180.8 mL vs 2 329.4 ±2 538.4 （W=495.5, P〈0.01） and 672.4±429.9 mL vs 1 662.6±1 932.1 （W=543.5, P〈0.01）. There were no remarkable differences in the pre-resection and post-resection blood losses between the two groups. The length of hospital stay was significantly shortened in LCVP group as compared with the control group, being 16.3±6.8 d vs 21.5 ± 8.6 d （W= 532.5, P〈0.05）.CONCLUSION： LCVP is easily achievable in technique. Maintenance of CVP ≤4 mmHg can help reduce blood loss during hepatectomy, shorten the length of hospital stay, and has no detrimental effects on hepatic or renal function.

Conventional transarterial chemoembolization vs microsphere embolization in hepatocellular carcinoma:A meta-analysis

AIM: To compare conventional transarterial chemoembolization (c-TACE) with microsphere embolization in hepatocellular carcinoma (HCC).

Partial splenectomy using a laparoscopic bipolar radiofrequency device:A case report

We report a 51-year-old female patient with a solitary lymphangioma located in the upper splenic pole which was managed successfully with laparoscopic partial splenectomy.Surgery lasted 170 min and did not require blood transfusions.The patient recovered well post-operatively and was asymptomatic at the 3-mo follow-up.She had a normal platelet count and no recurrence on ultrasonography or computed tomography.Laparoscopic partial splenectomy is a safe,minimally invasive technique for the treatment of solitary splenic lymphangiomas in the splenic pole.We performed the procedure using the HabibTM 4X device.This laparoscopic bipolar radiofrequency device ensured a "bloodless" splenic parenchymal resection.

Randomized clinical trial on seven-day-per-week continuous accelerated irradiation for patients with esophageal carcinoma: Preliminary report on tumor response and acute toxicity

AIM: Tumor response and normal tissue toxicity of seven-day-per-week continuous accelerated irradiation (CAIR) for patients with esophageal carcinoma were evaluated and compared to conventional irradiation (CR). METHODS: Sixty patients with squamous cell carcinoma of the esophagus were randomized into two groups: the CAIR group (30 patients) and the CR group (30 pa- tients). Patients in the CAIR group received radiotherapy (RT) with 2 Gy/fraction per day at 7 d/wk with a total dose of 50-70 Gy (average dose 64.2 Gy). The overall time of irradiation was 3.6-5.0 wk (average 4.6 wk). RT in the CR group was 2 Gy/fraction per day at 5 d/wk with a total dose of 40-70 Gy (average dose 61.7 Gy). The overall time of irradiation was 4.0-7.0 wk (average 6.4 wk). RESULTS: The data showed that the immediate tumor response to RT was better in the CAIR group than in the CR group. Efficiency rates (CR plus PR) were 82.8% (24/29) and 58.6% (17/29), respectively (P = 0.047). In both groups the incidences of esophagitis and tracheitis were insignificant (P = 0.376, 0.959), and no patient re- ceived toxicity that could not be tolerated. CONCLUSION: CAIR shortens overall treatment time and is well tolerated by patients. It may be superior to CR in enhancing the local response of tumor, but its remote effect for esophageal carcinoma awaits further follow-up.

Kinematics/Fuzzy Logic Combined Controller for Formation Control of Mobile Robots

A kinematics and fuzzy logic combined formation controller was proposed for leader-follower based formation control using backstepping method in order to accommodate the dynamics of the robot.The kinematics controller generates desired linear and angular velocities for follower robots,which make the configuration of follower robots coverage to the desired.The fuzzy logic controller takes dynamics of the leader and followers into consideration,which is built upon Mamdani fuzzy model.The force and torque acting on robots are described as linguistic variables and also 25 if-then rules are designed.In addition,the fuzzy logic controller adopts the Centroid of Area method as defuzzification strategy and makes robots’actual velocities converge to the expected which is generated by the kinematics controller.The innovation of the kinematics and fuzzy logic combined formation controller presented in the paper is that the perfect velocity tracking assumption is removed and realtime performance of the system is improved.Compared with traditional torque-computed controller,the velocity error convergence time in case of the proposed method is shorter than traditional torque-computed controller.The simulation results validate that the proposed controller can drive robot members to form the desired formation and formation tracking errors which can coverage to a neighborhood of the origin.Additionally,the simulations also show that the proposed method has better velocity convergence performance than traditional torque-computed method.

Genetic Diversity of Tea Plant(Camellia Sinensis(L.) O.Kuntze)in Wuling Mountainous Area Revealed by ISSR Marker

Genetic diversity and relationship of 183 tea germplasms were assessed by inter-simple sequence repeat(ISSR) marker.The study optimized the ISSR-PCR system for tea plants.Results show that genetic similarity among 183 tea ascensions was between 0.52-0.93,indicating a wide gene pool and a broad genetic variation of Wuling tea resources.The highest similarity of all materials between No1 and No2 was 0.93.Dendrogram of the183 tea germplasms were protracted by UPGMA clustering analysis also revealed the genetic diversity and relationship of the tea germplasms of Wuling mountainous area.Besides,fingerprint of the 183 tea germplasms were constructed.

Frame rate up-conversion using multiresolution critical point filters with occlusion refinement

In this paper, multiresolution critical-point filters （CPFs） are employed to image matching for frame rate up-conversion （FRUC）. By CPF matching, the dense motion field can be obtained for representing object motions accurately. However, the elastic motion model does not hold in the areas of occlusion, thus resulting in blur artifacts in the interpolated frame. To tackle this problem, we propose a new FRUC scheme using an occlusion refined CPF matching interpolation （ORCMI）. In the proposed approach, the occlusion refinement is based on a bidirectional CPF mapping. And the intermediate frames are generated by the bidirectional interpolation for non-occlusion pixels combined with unidirectional projection for the occlusion pixels. Ex- perimental results show that ORCMI improves the visual quality of the interpolated frames, especially at the occlusion regions. Compared to the block matching based FRUC algorithm, ORCM1 can achieve 1-2 dB PSNR gain for standard video sequences.

Effects of antiplatelet drug combined with magnesium sulfate on platelet function and trophoblast apoptosis in patients with preeclampsia

Objective: To investigate the effects of antiplatelet drug combined with magnesium sulfate on platelet function and trophoblast apoptosis in patients with preeclampsia. Methods: A total of 68 patients with preeclampsia who were treated in this hospital between September 2016 and September 2017 were chosen as the research subjects and divided into the control group (n=34) and the study group (n=34) by the random number table method. Control group received magnesium sulfate spasmolysis, and study group received low-dose aspirin combined with magnesium sulfate therapy. The differences in the levels of platelet function parameters as well as the expression levels of apoptosis-related genes and invasion-related genes in placental tissues were compared between the two groups of patients after treatment. Results:After treatment, the platelet function parameter PLT level in study group was higher than that in control group whereas MPV and PDW levels were lower than those in control group;pro-apoptosis genes Caspase-3, p53 and bax mRNA expression levels in placental tissues were lower than those of control group whereas anti-apoptosis gene bcl-2 mRNA expression level was higher than that of control group;pro-invasion genes MMP-2, MMP-9 and CXCL16 mRNA expression levels in placental tissues were higher than those of control group whereas anti-invasion genes RECK and DPPⅣ mRNA expression levels were lower than those of control group. Conclusion: Low-dose aspirin combined with magnesium sulfate treatment of patients with preeclampsia can effectively optimize the platelet function and inhibit the apoptosis of placental trophoblast cells and promote their invasion function.

Transarterial chemoembolization with PD-(L)1 inhibitors plus molecular targeted therapies for hepatocellular carcinoma(CHANCE001)

There is considerable potential for integrating transarterial chemoembolization(TACE),programmed death-(ligand)1(PD-[L]1)inhibitors,and molecular targeted treatments(MTT)in hepatocellular carcinoma(HCC).It is necessary to investigate the therapeutic efficacy and safety of TACE combined with PD-(L)1 inhibitors and MTT in real-world situations.In this nationwide,retrospective,cohort study,826 HCC patients receiving either TACE plus PD-(L)1 blockades and MTT(combination group,n=376)or TACE monotherapy(monotherapy group,n=450)were included from January 2018 to May 2021.The primary endpoint was progression-free survival(PFS)according to modified RECIST.The secondary outcomes included overall survival(OS),objective response rate(ORR),and safety.We performed propensity score matching approaches to reduce bias between two groups.After matching,228 pairs were included with a predominantly advanced disease population.Median PFS in combination group was 9.5 months(95%confidence interval[CI],8.4-11.0)versus 8.0 months(95%CI,6.6-9.5)(adjusted hazard ratio[HR],0.70,P=0.002).OS and ORR were also significantly higher in combination group(median OS,19.2[16.1-27.3]vs.15.7 months[13.0-20.2];adjusted HR,0.63,P=0.001;ORR,60.1%vs.32.0%;P<0.001).Grade 3/4 adverse events were observed at a rate of 15.8%and 7.5%in combination and monotherapy groups,respectively.Our results suggest that TACE plus PD-(L)1 blockades and MTT could significantly improve PFS,OS,and ORR versus TACE monotherapy for Chinese patients with predominantly advanced HCC in real-world practice,with an acceptable safety profile.

Prognostic Performance of the China Liver Cancer Staging System in Hepatocellular Carcinoma Following Transarterial Chemoembolization

Background and Aims:To validate prognostic performance of the China liver cancer(CNLC)staging system as well as to compare these parameters with those of the Barcelona Clinic Liver Cancer(BCLC)staging system for Chinese hepatocellular carcinoma(HCC)treated with transarterial chemoembolization(TACE).Methods:This multicenter retrospective study included 1,124 patients with HCC between January 2012 and December 2020 from six Chinese hospitals.Based on overall survival(OS),the prognostic performance outcomes for the CNLC and BCLC staging systems were compared by model discrimination[C statistic and Akaike information criterion(AIC)],monotonicity of the gradient(linear trend chi-square test),homogeneity(likelihood ratio chisquare test),and calibration(calibration plots).A prospective cohort of 44 patients receiving TACE-based therapy included between January 2021 and December 2022 was used to prospectively validate the outcomes.Results:Median OS was 19.1(18.2–20.0)months,with significant differences in OS between stages defined by the CNLC and BCLC observed(p<0.001).The CNLC performed better than the BCLC regarding model discrimination(C-index:0.661 vs.0.644;AIC:10,583.28 vs.10,583.72),model monotonicity of the gradient(linear trend chi-square test:66.107 vs.57.418;p<0.001),model homogeneity(159.2 vs.158.7;p<0.001).Both staging systems had good model calibration.Similar results were observed in the prospective cohort.Conclusions:Combining model discrimination,gradient monotonicity,homogeneity,and calibration,the CNLC performed better than the BCLC for Chinese HCC patients receiving TACE.

Physical human-robot interaction estimation based control scheme for a hydraulically actuated exoskeleton designed for power amplification

We proposed a lower extremity exoskeleton for power amplification that perceives intended human motion via humanexoskeleton interaction signals measured by biomedical or mechanical sensors, and estimates human gait trajectories to implement corresponding actions quickly and accurately. In this study, torque sensors mounted on the exoskeleton links are proposed for obtaining physical human-robot interaction（pHRI） torque information directly. A Kalman smoother is adopted for eliminating noise and smoothing the signal data. Simultaneously, the mapping from the pHRI torque to the human gait trajectory is defined. The mapping is derived from the real-time state of the robotic exoskeleton during movement. The walking phase is identified by the threshold approach using ground reaction force. Based on phase identification, the human gait can be estimated by applying the proposed algorithm, and then the gait is regarded as the reference input for the controller. A proportional-integral-derivative control strategy is constructed to drive the robotic exoskeleton to follow the human gait trajectory. Experiments were performed on a human subject who walked on the floor at a natural speed wearing the robotic exoskeleton. Experimental results show the effectiveness of the proposed strategy.

Blocking Posttranslational Core Fucosylation Ameliorates Rat Peritoneal Mesothelial Cell Epithelial-Mesenchymal Transition

Background：Core fucosylation （CF）,catalyzed by α-1,6 fucosyltransferase （Fut8） in mammals,plays an important role in pathological processes through posttranslational modification of key signaling receptor proteins,including transforming growth factor （TGF）-β receptors and platelet-derived growth factor （PDGF） receptors.However,its effect on peritoneal fibrosis is unknown.Here,we investigated its influence on epithelial-mesenchymal transition （EMT） of rat peritoneal mesothelial cells （PMCs） in vitro induced by a high-glucose （HG） culture solution.Methods：Rat PMCs were first cultured in a HG （2.5%） culture solution to observe the CF expression level （fluorescein isothiocyanate-lens culinaris agglutinin）,we next established a knockdown model of rat PMCs in vitro with Fut8 small interfering RNA （siRNA） to observe whether inhibiting CF decreases the messenger RNA （mRNA） expression and protein expression of Fut8 and reverses EMT status.Rat PMCs were randomly divided into control group,mock group （transfected with scrambled siRNA）,Fut8 siRNA group,HG group,HG ＋ mock group,and HG ＋ Fut8 siRNA group.Finally,we examined the activation of TGF-β/Smad2/3 signaling and PDGF/extracellular signal-regulated kinase （ERK） signaling to observe the influence of CF on them.Results：CF,Fut8 mRNA,and protein expression were all significantly upregulated in HG-induced EMT model than those in the control rat PMCs （P 〈 0.05）.Fut8 siRNA successfully blocked CF of TGF-β receptors and PDGF receptors and attenuated the EMT status （E-cadherin and α-SMA and phenotypic changes） in HG-induced rat PMCs.In TGF-β/Smad2/3 signaling,Fut8 siRNA did not suppress the protein expression of TGF-3 receptors and Smad2/3;however,it significantly suppressed the phosphowlation of Smad2/3 （relative expression folds of HG ＋ Fut8 group vs.HG group：7.6 ± 0.4 vs.15.1 ± 0.6,respectively,P 〈 0.05）.In PDGF/ERK signaling,Fut8 siRNA did not suppress the protein expression of PDGF receptors and ERK,but it significantly suppressed the phosphorylation of ERK （relative expression folds of HG ＋ Fut8 group vs.HG group：8.7 ± 0.9 vs.15.6 ± 1.2,respectively,P 〈 0.05）.Blocking CF inactivated the activities of TGF-β and PDGF signaling pathways,and subsequently blocked EMT.Conclusions：These results demonstrate that CF contributes to rat PMC EMT.and that blocking it attenuates EMT.CF regulation is a potential therapeutic target of peritoneal fibrosis.

Post-marketing Surveillance for Combined Oral Contraceptive Containing Desogestrel(Marvelon~) in Chinese Rural Areas

To assess the side effects and the continuation rate of combined oral contraceptive （COC） containing desogestrel （Marvelon） during 12 months. Methods This was a post-marketing surveillance study on Marvelon COC among 870 healthy rural women in 5 different counties of Jiangsu Province during 12 months. Results About 24.02% of the women who used Marvelon COC experienced side effects during 12 months. Gastrointestinal disorder, bleeding/spotting and chloasma were ranked the first three in the side effects. The rate of side effects of Marvelon COC users during the first 3 months in southern area of Jiangsu was significantly higher than that of users in northern area of Jiangsu. Most of the users did not experience obvious weight changes i.e., loss or increase in weight of more than 5 kg during 12 months. Blood pressure and biochemical indicators of almost 99% among users were within the normal range. The gross cumulative continuation rate for 12 months was 83.14%; the most common medical reason for discontinuation was gastrointestinal disorder. There was an increased risk of discontinuation use among women with lower educational level. Conclusion Marvelon COC brought fewer side effects and was well accepted when applied in Chinese rural women.

Video coding using geometry based block partitioning and reordering discrete cosine transform

Geometry based block partitioning （GBP） has been shown to achieve better performance than the tree structure based block partitioning （TSBP） of H.264. However, the residual blocks of GBP mode after motion compensation still present some non-vertical/non-horizontal orientations, and the conventional discrete cosine transform （DCT） may generate many high-frequency coefficients. To solve this problem, in this paper we propose a video coding approach by using GBP and reordering DCT （RDCT） techniques. In the proposed approach, GBP is first applied to partition the macroblocks. Then, before performing DCT, a reordering operation is used to adjust the pixel positions of the residual macroblocks based on the partition information. In this way, the partition information of GBP can be used to represent the reordering information of RDCT, and the bitrate can be reduced. Experimental results show that, compared to H.264/AVC, the proposed method achieves on average 6.38% and 5.69% bitrate reductions at low and high bitrates, respectively.