High-grade pancreatic intraepithelial neoplasia diagnosed based on changes in magnetic resonance cholangiopancreatography findings:A case report

BACKGROUND High-grade pancreatic intraepithelial neoplasia(PanIN)exhibits no mass and is not detected by any examination modalities.However,it can be diagnosed by pancreatic juice cytology from indirect findings.Most previous cases were diagnosed based on findings of a focal stricture of the main pancreatic duct(MPD)and caudal MPD dilatation and subsequent pancreatic juice cytology using endoscopic retrograde cholangiopancreatography(ERCP).We experienced a case of high-grade PanIN with an unclear MPD over a 20-mm range,but without caudal MPD dilatation on magnetic resonance cholangiopancreatography(MRCP).CASE SUMMARY A 60-year-old female patient underwent computed tomography for a follow-up of uterine cancer post-excision,which revealed pancreatic cysts.MRCP revealed an unclear MPD of the pancreatic body at a 20-mm length without caudal MPD dilatation.Thus,course observation was performed.After 24 mo,MRCP revealed an increased caudal MPD caliber and a larger pancreatic cyst.We performed ERCP and detected atypical cells suspected of adenocarcinoma by serial pancreatic juice aspiration cytology examination.We performed a distal pancreatectomy and obtained a histopathological diagnosis of high-grade PanIN.Pancreatic parenchyma invasion was not observed,and curative resection was achieved.CONCLUSION High-grade Pan-IN may cause MPD narrowing in a long range without caudal MPD dilatation.

Bulk geochemistry,Rb-Sr,Sm-Nd,and stable O-H isotope systematics of the Metzimevin high-grade iron ore deposit,Mbalam iron ore district,southern Cameroon

Bulk geochemistry,Sr,Nd,and O-H isotope systematics are reported for the first time on banded iron formation(BIF)-hosted high-grade iron ore at the northwestern segment of Congo Craton(CC).Located in Mbalam iron ore district,Southern Cameroon,Metzimevin iron ore deposit is a hematite-magnetite BIF system,dominated by SiO_(2)+Fe_(2)O_(3)(97.1 to 99.84 wt%),with low concentrations of clastic elements e.g.,Al_(2)O_(3),TiO_(2),and HFSE,depicting a nearly pure chemical precipitate.The REE+Y signature of the iron deposit displays strong positive Eu anomaly,strong negative Ce anomaly,and chondritic to superchondritic Y/Ho ratios,suggestive of formation by mixed seawater-high temperature hydrothermal fluids in oxidising environment.The^(87)Sr/^(86)Sr ratios of the BIF are higher than the maximum^(87)Sr/^(86)Sr evolution curves for all Archean reservoirs(bulk silicate earth,Archean crust and Archean seawater),indicating involvement of continentally-derived components during BIF formation and alteration.TheƐ_(Nd)(t)(+2.26 to+3.77)and Nd model age indicate that chemical constituents for the BIF were derived from undifferentiated crustal source,between 3.002 and 2.88 Ga.The variable and diverse O and H isotope data(−1.9‰to 17.3‰and−57‰to 136‰respectively)indicate that the Metzimevin iron ore formed initially from magmatic plumes and later enriched by magmatic-metamorphic-modified meteoric fluids.Mass balance calculations indicate mineralisation by combined leaching and precipitation,with an average iron enrichment factor of>2.67 and SiO_(2)depletion factor of>0.99.This is associated with an overall volume reduction of 28.27%,reflecting net leaching and volume collapse of the BIF protholith.

Wind-sand flow simulation and radius optimization of highway embankment under different vertical curve radius

It is of great practical value to explore the correlation between the vertical curve radius of desert highway and the increase of sand accumulation in local lines,and to select the appropriate vertical curve radius for reducing the risk of sand accumulation.In this study,three-dimensional models of desert highway embankments with different vertical curve radii were constructed,and Fluent software was used to simulate the wind-sand flow field and sand accumulation distribution of vertical curve embankments.The results show that:(1)Along the direction of the road,the concave and the convex vertical curve embankments have the effect of collecting and diverging the wind-sand flow,respectively.When the radius of the concave vertical curve is 3000 m,5000 m,8000 m,10000 m and 20000 m,the wind velocity in the middle of the vertical curve is 31.76%,22.58%,10.78%,10.53%and 10.44%,higher than that at both ends.When the radius of the convex vertical curve is 6500 m,8000 m,10000 m,20000 m and 30000 m,the wind velocity at both ends of the vertical curve is 14.06%,9.99%,6.14%,3.22%and 2.41%,higher than that in the middle.The diversion effect also decreases with the increase of the radius.(2)The conductivity of the concave and convex vertical curve embankments with different radii is greater than 1,which is the sediment transport roadbed.The conductivity increases with the increase of radius and gradually tends to be stable.When the radius of the concave and convex vertical curves reaches 8000 m and 20000 m respectively,the phenomenon of sand accumulation is no longer serious.Under the same radius condition,the concave vertical curve embankment is more prone to sand accumulation than the convex one.(3)Considering the strength of the collection and diversion of the vertical curve embankment with different radii,and the sand accumulation of the vertical curve embankment in the desert section of Wuma Expressway,the radius of the concave vertical curve is not less than 8000 m,and the radius of the convex vertical curve is not less than 20000 m,which can effectively reduce the sand accumulation of the vertical curve embankment.In the desert highway area,the research results of this paper can provide reference for the design of vertical curve to ensure the safe operation of desert highway.

Management of retroperitoneal high-grade serous carcinoma of unknown origin:A case report

BACKGROUND Retroperitoneal high-grade serous carcinoma(HGSC)of unknown origin is a sporadic tumor that can originate from ovarian cancer.Herein,we report the case of a woman with retroperitoneal HGSC of unknown origin and describe how she was diagnosed and treated.CASE SUMMARY A 71-year-old female presented with the tumor marker CA125 elevated to 1041.9 U/mL upon a regular health examination.Computed tomography revealed retroperitoneal lymph node enlargement.Subsequently,positron emission tomography scanning revealed lesions with increased F-18 fluorodeoxyglucose uptake at the nodes.As a result,she underwent laparoscopic lymph node resection,and pathology revealed metastatic adenocarcinoma with CK7(+),PAX8(+),WT1(+),PR(-),and p53 mutational loss of expression,indicating that the origin may be from the adnexa.The patient was admitted to our ward and underwent laparoscopic staging;however,the pathological results were negative.Under the suspicion of retroperitoneal HGSC of unknown origin,chemotherapy and targeted therapy were initiated.Tumor marker levels decreased after treatment.CONCLUSION We present a case of HGSC of unknown origin managed using retroperitoneal lymphadenectomy,staging surgery,chemotherapy,and targeted therapy.

Cost Control Strategies for Hubei General Highway Greening Project

In order to respond to the national policy of focusing on the service of building a new development pattern and promoting high-quality development,and to reduce the cost of greening projects while ensuring the effect of highway landscape,a process and cost control points of highway greening design,construction,and maintenance are summarized through a review of the literature.Additionally,this paper examines the attributes of highway greening and proposes cost control strategies that are aligned with these attributes.It is proposed that the implementation of cost control strategies for highway greening should commence at the project establishment phase,with the objective of establishing a comprehensive and effective cost management control system.While guaranteeing the greening landscape effect and the duration of the project,it is essential to regulate the crucial nodes in each phase of the design,construction,and maintenance process.Furthermore,it is vital to facilitate close collaboration between all parties involved,thereby reducing costs,conserving resources,and lowering energy consumption.This approach can also lead to enhanced economic and social benefits for highway greening projects.

Characteristics and risk factor analyses of high-grade intraepithelial neoplasia in older patients with colorectal polyps

BACKGROUND According to the degree of intradermal neoplasia in the colorectal exhalation,it can be divided into two grades:Low-grade intraepithelial neoplasia(LGIN)and high-grade intraepithelial neoplasia(HGIN).Currently,it is difficult to accurately diagnose LGIN and HGIN through imaging,and clinical diagnosis depends on postoperative histopathological diagnosis.A more accurate method for evaluating HGIN preoperatively is urgently needed in the surgical treatment and nursing intervention of colorectal polyps.AIM To explore the characteristics and risk factors of HGIN in older patients with colorectal polyps.METHODS We selected 84 older patients diagnosed with HGIN as the HGIN group(n=95 colonic polyps)and 112 older patients diagnosed with LGIN as the LGIN group(n=132 colonic polyps)from Shandong Provincial Hospital Affiliated to Shandong First Medical University.The endoscopic features,demographic characteristics,and clinical manifestations of the two patient groups were compared,and a logistic regression model was used to analyze the risk factors for HGIN in these patients.RESULTS The HGIN group was older and had a higher number of sigmoid colon polyps,rectal polyps,pedunculated polyps,polyps≥1.0 cm in size,polyps with surface congestion,polyps with surface depression,and polyps with villous/tubular adenomas,a higher proportion of patients with diabetes and a family history of colorectal cancer,patients who experienced rectal bleeding or occult blood,patients with elevated carcinoembryonic antigen(CEA)and cancer antigen 199(CA199),and lower nutritional levels and higher frailty levels.The polyp location(in the sigmoid colon or rectum),polyp diameter(≥1.0 cm),pathological diagnosis of(villous/tubular adenoma),family history of colorectal cancer,rectal bleeding or occult blood,elevated serum CEA and CA199 levels,lower nutritional levels and higher frailty levels also are independent risk factors for HGIN.CONCLUSION The occurrence of high-grade neoplastic transformation in colorectal polyps is closely associated with their location,size,villous/tubular characteristics,family history,elevated levels of tumor markers,and lower nutritional levels and higher frailty levels.

High-grade serous carcinoma of the fallopian tube in a young woman with chromosomal 4q abnormality:A case report

BACKGROUND Few studies have reported an association between an increased risk of acquiring cancers and survival in patients with 4q deletion syndrome.This study presents a rare association between chromosome 4q abnormalities and fallopian tube highgrade serous carcinoma(HGSC)in a young woman.CASE SUMMARY A 35-year-old woman presented with acute dull abdominal pain and a known chromosomal abnormality involving 4q13.3 duplication and 4q23q24 deletion.Upon arrival at the emergency room,her abdomen appeared ovoid and distended with palpable shifting dullness.Ascites were identified through abdominal ultrasound,and computed tomography revealed an omentum cake and an enlarged bilateral adnexa.Blood tests showed elevated CA-125 levels.Paracentesis was conducted,and immunohistochemistry indicated that the cancer cells favored an ovarian origin,making us suspect ovarian cancer.The patient underwent debulking surgery,which led to a diagnosis of stage IIIC HGSC of the fallopian tube.Subsequently,the patient received adjuvant chemotherapy with carboplatin and paclitaxel,resulting in stable current condition.CONCLUSION This study demonstrates a rare correlation between a chromosome 4q abnormality and HGSC.UBE2D3 may affect crucial cancer-related pathways,including P53,BRCA,cyclin D,and tyrosine kinase receptors,thereby possibly contributing to cancer development.In addition,ADH1 and DDIT4 may be potential influencers of both carcinogenic and therapeutic responses.

Transformation of marginal zone lymphoma into high-grade B-cell lymphoma expressing terminal deoxynucleotidyl transferase:A case report

BACKGROUND High-grade B-cell lymphoma(HGBL)is an unusual malignancy that includes myelocytomatosis viral oncogene(MYC),B-cell lymphoma-2(BCL-2),and/or BCL-6 rearrangements,termed double-hit or triple-hit lymphomas,and HGBL-not otherwise specific(HGBL-NOS),which are morphologically characteristic of HGBL but lack MYC,BCL-2,or BCL-6 rearrangements.HGBL is partially transformed by follicular lymphoma and other indolent lymphoma,with few cases of marginal zone lymphoma(MZL)transformation.HGBL often has a poor prognosis and intensive therapy is currently mainly advocated,but there is no good treatment for these patients who cannot tolerate chemotherapy.CASE SUMMARY We reported a case of MZL transformed into HGBL-NOS with TP53 mutation and terminal deoxynucleotidyl transferase expression.Gene analysis revealed the gene expression profile was identical in the pre-and post-transformed tissues,suggesting that the two diseases are homologous,not secondary tumors.The chemotherapy was ineffective and the side effect was severe,so we tried combination therapy including venetoclax and obinutuzumab.The patient tolerated treatment well,and reached partial response.The patient had recurrence of hepatocellular carcinoma and died of multifunctional organ failure.He survived for 12 months after diagnosis.CONCLUSION Venetoclax combined with obinutuzumab might improve the survival in some HGBL patients,who are unsuitable for chemotherapy.

Intelligent Diagnosis of Highway Bridge Technical Condition Based on Defect Information

In the bridge technical condition assessment standards,the evaluation of bridge conditions primarily relies on the defects identified through manual inspections,which are determined using the comprehensive hierarchical analysis method.However,the relationship between the defects and the technical condition of the bridges warrants further exploration.To address this situation,this paper proposes a machine learning-based intelligent diagnosis model for the technical condition of highway bridges.Firstly,collect the inspection records of highway bridges in a certain region of China,then standardize the severity of diverse defects in accordance with relevant specifications.Secondly,in order to enhance the independence between the defects,the key defect indicators were screened using Principal Component Analysis(PCA)in combination with the weights of the building blocks.Based on this,an enhanced Naive Bayesian Classification(NBC)algorithm is established for the intelligent diagnosis of technical conditions of highway bridges,juxtaposed with four other algorithms for comparison.Finally,key defect variables that affect changes in bridge grades are discussed.The results showed that the technical condition level of the superstructure had the highest correlation with cracks;the PCA-NBC algorithm achieved an accuracy of 93.50%of the predicted values,which was the highest improvement of 19.43%over other methods.The purpose of this paper is to provide inspectors with a convenient and predictive information-rich method to intelligently diagnose the technical condition of bridges based on bridge defects.The results of this research can help bridge inspectors and even non-specialists to better understand the condition of bridge defects.

Analysis of the Application of Span-Bridge Technology for Building Highway Tunnels that Go Over Solutional Caves

This article presents a real engineering project showcasing the application of span-bridge construction technology for building a highway that goes over a solutional cave.An overview of the project and the details of applying this technology in highway construction are provided.Besides,strategies for enhancing its construction quality are also proposed.The objective of this analysis is to improve the safety and quality of similar projects.

Site Management Strategy in Highway Project Management

Highway project management involves overseeing the on-site construction of a highway project,taking into account the specific circumstances and conditions of the site.This type of management requires a high level of expertise and is characterized by its dynamic and systematic approach.Effective on-site management can ensure the quality,cost-saving,smooth progress,and safety of highway construction.However,there are still some problems in the implementation of site management in some highway projects,which seriously affect the improvement of site management.This paper analyzes the characteristics and existing problems of highway engineering management,and puts forward the effective strategies of site management,hoping that this study will help to improve highway engineering site management.

Application of Earthquake-Proof Design in Highway Bridge Design

Highway bridges are an important part of transportation infrastructure.With the rapid development of transportation,the design of bridge construction has received significant attention.The complex environment of some regions necessitates the selection of seismic design to improve the stability of the structure during the design phase of highway bridge construction.This article briefly discusses bridge structures that may be subject to seismic hazards and analyzes seismic design standards to explore their application in the design process of highway bridges,with the aim of providing support for bridge construction.

Analysis of the Current Situation of Cost Management and Control of Highway Construction Projects

The highway engineering process is complex,coupled with a relatively long construction period,hence requires increased coordination between participating units to prevent economic disputes and efficiency losses.The main body of the construction project needs to strengthen the management and control of funds.In this regard,this paper analyzes the importance of cost management in highway projects by clarifying and analyzing the current cost management status quo problems and causes.The highway engineering cost control strategy and implementation methods are summarized to provide references for improving the quality of highway engineering.

Mountain Highway Design Based on New Green Design Concepts

This article analyzes the implementation of new environmentally friendly design practices in the construction of mountain highways.It covers topics such as green highway design concepts,alignment principles,and green practices specifically for mountainous highway design.This analysis aims to provide useful insights for creating green mountain highways that meet the demands of modern times.

Settlement Control Standards of Construction and Expansion for Mountainous Highway Roadbeds

This article analyzes the differential settlement of new and old roadbeds after widening and its characteristics based on a highway reconstruction and expansion project case study.The research proposes a subgrade settlement control standard that states that the maximum differential settlement value should be less than 5 cm when the embankment fill height exceeds 20 m.Similarly,the maximum differential settlement value should be less than 10 cm when the embankment fill height does not exceed 20 m.The findings of the study can provide a useful reference for the design of roadbed widening in highway reconstruction and expansion projects.

Application Strategies of BIM Technology in Highway Electromechanical Engineering

The transportation system is vital for social and economic development.With the rapid economic development,the demand for highways has been increasing.Mechanical and electrical engineering is a crucial part of highway construction,affecting the expressway’s later use.Applying building information modeling(BIM)technology in highway electromechanical engineering allows for the visibility and simulation of mechanical and electrical engineering construction,providing scientific guidance for construction.In this research,the author analyzes the advantages of BIM technology in highway electromechanical engineering and the basic composition of electromechanical engineering.The research proposes strategies and cases for applying BIM technology in highway electromechanical engineering.The ultimate goal of this research is to improve the construction of highways in terms of electromechanical engineering.

Cost Control Strategies in the Pre-Construction Period of Highway Construction

Effective cost control in the investment and design phases of highway construction is crucial for managing project expenses.However,current management practices often overlook pre-construction cost management,leading to budget overruns and project delays during later stages.To ensure the smooth execution and cost control of highway construction projects,this paper examines the significance of cost control,evaluates the current state and challenges of highway construction,and proposes strategies for cost management.These strategies aim to establish a robust foundation for cost management in highway projects.

Analysis and Comparison of Slope-cutting Widening Schemes in Highway Reconstruction and Expansion Project Based on MIDAS Software

In this paper,the geological condition of the right-side slope of the K114+694–K115+162 section of Yong-tai-wen Expressway is investigated and analyzed with the results showing that the strength of rock mass is the main contributor to the stability of the slope.Then,two widening schemes are proposed,which are the steep slope with strong support and the gentle slope with general support schemes.The static/slope module of MIDAS GTS finite element analysis software and the strength reduction method were used to compare the two schemes.The results show that the steep slope with a strong support scheme has obvious advantages in land requisition,environmental protection,and safety and is more suitable for reconstructing and expanding the highway slope.

Application Strategies of Shotcrete Anchor Support Technology in Highway Bridge and Tunnel Engineering

This article analyzes the application strategies of shotcrete anchor support technology using a highway bridge-tunnel construction project as an example.The article covers various strategies,including support plan formulation,mortar shotcrete anchor construction,grid steel frame construction,steel mesh construction,and concrete support construction.This analysis aims to provide a guideline for those interested in applying this technology and improving the quality and safety of highway bridges and tunnels construction.

Analysis of Roadbed Pavement Designs for Highway Reconstruction and Upgrading

This paper focuses on the route and roadbed pavement design in highway reconstruction and upgrading projects.It discusses the importance of project design for highway reconstruction and upgrading,highlighting key aspects of route design and roadbed pavement design.The analysis reveals that the main design considerations in these projects include controlling factors of route reconstruction,expansion,and upgrading,as well as route plan design and longitudinal section design combined with roadbed pavement.In roadbed pavement design,it is crucial for designers to thoroughly collect existing data and make reasonable use of the current roadbed and pavement to develop a comprehensive design scheme.This analysis aims to provide a reference for the reasonable design of such projects.