Asymptomatic low-grade appendiceal mucinous neoplasm:A case report

BACKGROUND Low-grade appendiceal neoplasms(LAMN)are characterized by low incidence and atypical clinical presentations,often leading to misdiagnosis as acute or chronic appendicitis before surgery.The primary diagnostic tool for LAMN is abdominal computed tomography(CT)imaging.Surgical resection remains the cornerstone of LAMN management,necessitating en bloc tumor excision to minimize the risk of iatrogenic rupture.Laparoscopy,known for its minimal invasiveness,reduced postoperative discomfort,and expedited recovery,is a safe and reliable approach for LAMN treatment.Despite the possibility of pseudomyxoma peritonei development,appendectomy and partial appendectomy generally result in negative tumor margins and favorable outcomes,which can be attributed to the disease’s slow growth and lower malignancy.CASE SUMMARY A 71-year-old male patient was admitted to our hospital with a pelvic spaceoccupying lesion detected 1 mo prior.Physical examination showed a soft abdomen without tenderness or rebound and no palpable masses.No shifting dullness was noted,and digital rectal examination revealed no palpable mass.Enteroscopy revealed a raised,smooth-surfaced mass measuring 3.0 cm in the cecum.Abdominal contrast-enhanced CT showed a markedly thickened and dilated appendix with visible cystic shadows.Laparoscopic surgery was performed and revealed a significantly dilated appendix,leading to laparoscopic resection of the appendix and part of the cecum.Post-surgical pathologic analysis confirmed LAMN.The patient received symptomatic and supportive post-operative care and was discharged on postoperative day 4 without complications such as abdominal bleeding,intestinal obstruction,or incision infection.No tumor recurrence was observed during a 7-mo follow-up period.CONCLUSION LAMN is a rare disease that lacks specific clinical manifestations.Abdominal CT plays a crucial role in diagnosing LAMN,and laparoscopic surgery is a safe and effective diagnostic and therapeutic approach.

Low-grade myofibrosarcoma of the maxillary sinus:Two case reports

BACKGROUND Low-grade myofibroblastic sarcoma(LGMS)is an extremely rare tumor characterized by the malignant proliferation of myofibroblasts.LGMS most commonly develops in adults,predominantly in males,in the head and neck region,oral cavity,especially on the tongue,mandible,and larynx.This article presents 2 cases of LGMS localized to the maxillary sinus and provides an overview of the available literature.CASE SUMMARY Two patients with LGMS located in the maxillary sinus underwent surgery at the Department of Head and Neck Surgery.Case 1:A 46-year-old patient was admitted to the clinic with suspected LGMS recurrence in the right maxillary sinus(rT4aN0M0),with symptoms of pain in the suborbital area,watering of the right eye,thick discharge from the right nostril,and augmented facial asymmetry.After open biopsy-confirmed LGMS,the patient underwent expanded maxillectomy of the right side with immediate palate reconstruction using a microvascular skin flap harvested surgically from the middle arm.The patient qualified for adjuvant radiotherapy for the postoperative bed,with an additional margin.Currently,the patient is under 1.5 years of observation with no evidence of disease.Case 2:A 45-year-old man was admitted to our clinic with facial asymmetry,strabismus,exophthalmos,and visual impairment in the right eye.Six months earlier,the patient had undergone partial jaw resection at another hospital for fibromatosis.A contrast-enhanced computed tomography scan revealed a tumor mass in the postoperative log after an earlier procedure.An open biopsy confirmed lowgrade fibrosarcoma(rT4aN0M0).The patient qualified for an extended total right maxillectomy with orbital excision and right hemimandibulectomy with immediate microvascular reconstruction using an anterolateral thigh flap.The patient subsequently underwent adjuvant radiotherapy to the postoperative area.After 9 months,recurrence occurred in the right mandibular arch below the irradiated area.The lesion infiltrated the base of the skull,which warranted the withdrawal of radiotherapy and salvage surgery.The patient qualified for palliative chemotherapy with a regimen of doxorubicin+dacarbazine+cyclophosphamide and palliative radiotherapy for bone metastases.The patient died 26 months after surgical treatment.The cases have been assessed and compared with cases in the literature.CONCLUSION No specific diagnostic criteria or treatment strategies have been developed for LGMS.The treatment used for LGMS is the same as that used for sinonasal cancer radical tumor excision;adjuvant radiotherapy or chemoradiotherapy should also be considered.They have low malignant potential but are highly invasive,tend to recur,and metastasize to distant sites.Patients should undergo regular follow-up examinations to detect recurrence or metastasis at an early stage.Patients should be treated and observed at the highest referral centers.

Thermally Chargeable Proton Capacitor Based on Redox-Active Effect for Energy Storage and Low-Grade Heat Conversion

Thermal energy is abundantly available in our daily life and industrial production,and especially,low-grade heat is often regarded as a byproduct.Collecting and utilizing this ignored energy by low-cost and simple technologies may become a smart countermeasure to relieve the energy crisis.Here,a unique device has been demonstrated to achieve high value-added conversion of low-grade heat by introducing redox-active organic alizarin(AZ)onto N-doped hollow carbon nanofibers(N–HCNF)surface.As-prepared N–HCNF/AZ can deliver a high specific capacitance of 514.3 F g^(-1)(at 1 A g^(-1))and an outstanding rate capability of 60.3%even at 50 A g^(-1).Meanwhile,the assembled symmetric proton capacitor can deliver a high energy density of 28.0 Wh kg^(-1) at 350.0 W kg^(-1) and a maximum power density of 35.0 kW kg^(-1) at 17.0 Wh kg^(-1).Significantly,the thermally chargeable proton capacitors can attain a surprisingly high Seebeck coefficient of 15.3 mV K^(-1) and a power factor of 6.02µW g^(-1).Taking advantage of such high performance,a satisfying open-circuit voltage of 481.0 mV with a temperature difference of 54 K is achieved.This research provides new insights into construction of high value-added energy systems requiring high electrochemical performances.

Anlotinib in combination with pembrolizumab for low-grade myofibroblastic sarcoma of the pancreas: A case report

BACKGROUND Low-grade myofibroblastic sarcoma(LGMS)is a rare spindle cell sarcoma espe-cially in the pancreas,with myofibroblastic differentiation.Hitherto,only a few cases have been reported.CASE SUMMARY Herein,we report a case involving the discovery of a pancreatic mass detected during a routine physical examination.Subsequent imaging and pathological tests of the patient led to the diagnosis of LGMS of the pancreas.Following surgical intervention,the patient experienced recurrence and metastasis.Conventional treatment is not effective for postoperative recurrent pancreatic LGMS with multiple metastases.After communicating with the patients and their families,informed consent was obtained for the treatment of anlotinib combined with pembrolizumab.Evaluation of imaging and clinical symptoms post-treatment revealed a relatively favorable response to the combination of anlotinib and pembrolizumab.CONCLUSION Based on the comprehensive literature review,our report aimed to provide evidence for a better understanding of the disease characteristics,diagnostic criteria,imaging findings,and identification of LGMS.And explore novel treatment strategies for this disease.

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.

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.

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.

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.

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 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.

Review of Power Supply and Distribution Construction Technology for Highway Electromechanical Engineering

In recent years,China has made significant progress in the construction of highways,resulting in an improved highway network that has provided robust support for economic and social development.However,the rapid expansion of highway construction,power supply,and distribution has led to several challenges in mechanical and electrical engineering technology.Ensuring the safe,stable,and cost-effective operation of the power supply and distribution system to meet the diverse requirements of highway operations has become a pressing issue.This article takes an example of a highway electromechanical engineering power supply and distribution construction project to provide insight into the construction process of highway electromechanical engineering power supply and distribution technology.

Hepatic steatosis,low-grade chronic inflammation and hormone/growth factor/adipokine imbalance

Non-alcoholic fatty liver disease (NAFLD), a further expression of metabolic syndrome, strictly linked to obesity and diabetes mellitus, is characterized by insulin resistance (IR), elevated serum levels of free fatty acids and fatty infi ltration of the liver, which is known as hepatic steatosis. Hepatocyte apoptosis is a key feature of this disease and correlates with its severity. Free-fatty-acidinduced toxicity represents one of mechanisms for the pathogenesis of NAFLD and hormones, growth factors and adipokines influence also play a key role. This review highlights the various pathways that contribute to the development of hepatic steatosis. Circulating concentrations of inflammatory cytokines are reckoned to be the most important factor in causing and maintaining IR. Low-grade chronic inflammation is fundamental in the progression of NAFLD toward higher risk cirrhotic states.

Low-grade myofibroblastic sarcoma of the palate

Low-grade myofibroblastic sarcoma （LGMS） is a rare, malignant tumor with myofibroblastic differentiation. Despite it being classified as a distinct entity by the World Health Organization, a few cases were reported in the oral and maxillofacial region. Here, a LGMS developed on the palate of a 73-year-old man who presented with a 1-cm tumor on the posterior border of the palate. Based on the histological and immunohistochemical features, a diagnosis of LGMS was established. The tumor was resected, and no recurrence was observed over 2 years. Although the tongue is the most preferred site for LGMS, it may occur in any region of the oral cavity.

Even low-grade inflammation impacts on small intestinal function

Independent of the cause and location,inflammation-even when minimal-has clear effects on gastrointestinal morphology and function.These result in altered digestion,absorption and barrier function.There is evidence of reduced villus height and crypt depth,increased permeability,as well as altered sugar and peptide absorption in the small intestine after induction of inflammation in experimental models,which is supported by some clinical data.Identification of inflammatory factors which may promote the process of gastrointestinal dysfunction as well as clinical research to verify experimental observations of inflammatory modulation of gastrointestinal function are required.Moreover,nutritional strategies to support functional restitution are needed.

Optimal management of biopsy-proven low-grade gastric dysplasia

Gastric adenocarcinoma generally culminates via the inflammation-metaplasia-dysplasia-carcinoma sequence progression. The prevalence of gastric adenomas shows marked geographic variation. Recently, the rate of diagnosis of low-grade dysplasia(LGD) has increased due to increased use of upper endoscopy. Many investigators have reported that gastric highgrade dysplasia has high potential for malignancy and should be removed; however, the treatment for gastric LGD remains controversial. Although the risk of LGD progression to invasive carcinoma has been reported to be inconsistent, progression has been observed during follow-up. Additionally, the rate of upgraded diagnosis in biopsy-proven LGD is high. Therefore, endoscopic resection(ER) may be useful in the treatment and diagnosis of LGD, especially if lesions are found to have risk factors for upgraded histology after ER, such as large size, surface erythema or depressed morphology. Fatal complications in endoscopic submucosal dissection(ESD) are extremely low and its therapeutic and diagnostic outcomes are excellent. Therefore, ESD should be applied preferentially instead of endoscopic mucosal resection.

Hydrometallurgical leaching and kinetic modeling of low-grade manganese ore with banana peel in sulfuric acid

Manganese was leached from a low-grade manganese ore(LGMO)using banana peel as the reductant in a dilute sulfuric acid medium.The effects of banana peel amount,H2SO4 concentration,reaction temperature,and time on Mn leaching from the complex LGMO were studied.A leaching efficiency of~98%was achieved at a leaching time of 2 h,banana peel amount of 4 g,leaching temperature of 120°C,manganese ore amount of 5 g,and sulfuric acid concentration of 15vol%.The phase,microstructural,and chemical analyses of LGMO samples before and after the leaching process confirmed the successful leaching of manganese.Furthermore,the leaching process followed the shrinking core model and the leaching rate was controlled by a surface chemical reaction(1−(1−x)^1/3=kt)mechanism with an apparent activation energy of 40.19 kJ·mol^−1.

Recovery of zinc from low-grade zinc oxide ores by solvent extraction

The recovery of zinc from low-grade zinc oxide ores with solvent extraction-electrowinning technique was investigated by using D2EHPA as extractant and 260 # kerosene as diluent. The results show that it is possible to selectively leach zinc from the ores by heap leaching. The zinc concentration of leach solution in the first leaching cycle is 32.57 g/L, and in the sixteenth cycle the zinc concentration is 8.27g/L after solvent extraction. The leaching solution is subjected to solvent extraction, scrubbing and selective stripping for enrichment of zinc and removal of impurities. The pregnant zinc sulfate solution produced from the stripping cycle is suitable for zinc electrowinning. Extra-pure zinc metal was obtained in the electrowinning test under conventional conditions.