Atrial septal hematogenous cyst with calcification mimicking myxoma: A rare case.

A 61-year-old female presented with right atrial mass during physical examination. Contrast-enhanced left heart echocardiography revealed a mass with the size of 32*23 mm in the right atrium, attached to the atrial septum; there was a certain degree of activity and deformation. MRI showed a mass of about 35*22 mm in the right atrium adjacent to the atrial septum, which was diagnosed with right atrial myxoma. Intraoperative TEE showed that the mass was located in the atrial septum close to the inferior vena cava and spontaneous echo contrast with hyperechoic images within the mass. The lesion was resected under cardiopulmonary bypass. Pathological examination revealed that the filling defect was an atrial septal hematogenous cyst with calcification.

A detailed dosimetric comparative study of IMRT and VMAT in normal brain tissues for nasopharyngeal carcinoma patients treated with radiotherapy.

Background: Radiotherapy (RT) is the primary treatment for nasopharyngeal carcinoma (NPC). However, it can cause implicit RT-induced injury by irradiating normal brain tissue. To date, there have been no detailed reports on the radiated exact location in the brain, the corresponding radiation dose, and their relationship. Methods: We analyzed 803 Chinese NPC patients treated with RT and used a CT brain template in a Montreal Neurological Institute (MNI) space to compare the group differences in RT dose distribution for different RT technologies (IMRT or VMAT). Results: Brain regions that received high doses (>50 Gy) of radiation were mainly located in parts of the temporal and limbic lobes, where radioactive damage often occurs. Brain regions that accepted higher doses with IMRT were mainly located near the anterior region of the nasopharyngeal tumor, while brain regions that accepted higher doses with VMAT were mainly located near the posterior region of the tumor. No significant difference was detected between IMRT and VMAT for T1 stage patients. For T2 stage patients, differences were widely distributed, with VMAT showing a significant dose advantage in protecting the normal brain tissue. For T3 stage patients, VMAT showed an advantage in the superior temporal gyrus and limbic lobe, while IMRT showed an advantage in the posterior cerebellum. For T4 stage patients, VMAT showed a disadvantage in protecting the normal brain tissue. These results indicate that IMRT and VMAT have their own advantages in sparing different organs at risk (OARs) in the brain for different T stages of NPC patients treated with RT. Conclusion: Our approach for analyzing dosimetric characteristics in a standard MNI space for Chinese NPC patients provides greater convenience in toxicity and dosimetry analysis with superior localization accuracy. Using this method, we found interesting differences from previous reports: VMAT showed a disadvantage in protecting the normal brain tissue for T4 stage NPC patients.

Dosimetric advantages of robust optimization combined with flattening filter free in treating cancer of the left breast.

OBJECTIVE: By comparing the target dose distribution with or without the robust optimization, the dosimetric advantages of robust optimization and flattening filter free (FFF) in radiation therapy for postmastectomy cancer of the left breast was explored when part of the chest wall target was moved out in case of respiratory motion. MATERIALS AND METHODS: This is a retrospective study. The data of 21 postmastectomy patients with cancer of the left breast from 2019 to 2020 were retrospectively collected. The planned target volume (PTV) dose was prescribed 50 Gy/25 fractions and the treatment plans were designed using 6 MV FFF X ray and volumetric modulated arc therapy (VMAT) technology in RayStation treatment planning system (TPS), with and without robust optimization. The movement of the target area of the internal chest wall (0.50 cm) caused by respiratory movement was simulated by moving the isocenter of the beams. RESULTS: When the chest wall target moved outward, the PTV target area D98, D95, D2, conformity index (CI) and homogeneity index (HI) with robust optimization were better than those without robust optimization. The coverage rate of Planned Target Volume-Chest (PTV-T) V50 with robust optimization was significantly higher than that with no-robust optimization (P<0.001). Clinical target volume (CTV) V50 coverage with robust optimization was 14.49% higher than that with no-robust optimization. In terms of organ-at-risk parameters, the average spinal cord dose of the plan with robust optimization was 13.19% lower than that of the plan with no-robust optimization, and the Lung-L V5 of the plan with no-robust optimization was slightly (1.94%) lower than that of the plan with robust optimization. There was no significant difference in machine execution efficiency between the two groups (P>0.05). CONCLUSIONS: Robust optimization could be adopted in the postoperative radiotherapy planning for cancer in the left breast, for it ensures that the target dose coverage and the dose limit of organ-at-risk still meet the clinical requirements under condition of chest wall displacement caused by respiratory movement.

Valve replacement or repair in native mitral valve infective endocarditis-Which is better? A meta-analysis and systematic review.

BACKGROUND: Native mitral valve infective endocarditis (IE) plagues patients and surgeons alike because of its high mortality and recurrence rates as well as poor prognosis. Mitral valve repair (MVP) and mitral valve replacement (MVR) are two main surgical methods. However, the question of which benefits patients more remains controversial. Thus, we conducted a meta-analysis to systematically review the two approaches, focusing on the early survival rate and long-term outcomes. METHODS: A meta-analysis and systematic review were conducted using studies sourced from the PubMed, Embase, and Cochrane literature databases to compare MVP and MVR, with data extracted for baseline characteristics, mortality, survival, recurrent endocarditis, and valve reoperation. Risk ratio (RR) or hazard ratio (HR) values were calculated, and publication bias was tested. RESULTS: A total of 17 relevant publications with a total population of 3759 patients, with 1180 patients having undergone MVP and 2579 patients having undergone MVR, respectively, were analyzed. Patients who underwent MVP may benefit from a lower risk of early mortality (RR, 0.51; 95% confidence interval [CI], 0.39-0.66; p < .00001), a higher long-term survival rate (HR, 0.69; 95% CI, 0.58-0.81; p < .001; I2 = 0%), and a lower risk of recurrence (RR, 0.66; 95% CI, 0.40-1.09; p = .10; I2 = 0%). However, a similar risk of reoperation was observed for both groups (RR, 1.02; 95% CI, 0.36-2.91; p = .96; I2 = 43%). CONCLUSION: This meta-analysis suggests that MVP may lead to better outcomes compared to MVR. Among patients with mitral valve IE, MVP can reduce in-hospital mortality, improve long-term survival, and has a lower risk of recurrent endocarditis. As a result, MVP may be suitable as a primary treatment choice and should be considered whenever possible in most IE patients.

Assessment of water pollution in the Tibetan Plateau with contributions from agricultural and economic sectors: a case study of Lhasa River Basin.

The freshwater environment of watersheds in the Tibetan Plateau is bound with the safety of the Asian Water Tower. In this study, nitrogen (N) and phosphorus (P) loads delivered to freshwater and the associated gray water footprint (GWF) in the agriculture, tourism, domestic life, and industrial sectors were estimated to assess the seasonal and annual characteristics of the water pollution levels (WPLs) in the Lhasa River Basin from 2006 to 2018, and WPL calculations were compared with actual water quality measurements from 2017 to 2018. We found that more than 90% of the GWF came from anthropogenic sources. From the perspective of the whole basin, domestic life was the largest contributor to both N-related GWFs (52%) and P-related GWFs (50%), followed by agriculture for N-related GWFs (32%) and tourism industry for P-related GWFs (30%). The N emissions into the freshwater environment exceeded the maximum assimilation capacity of the watersheds in individual years at both seasonal and annual scales, while P emissions were completely within the pollution assimilative capacity. Besides, we found the serious N pollution near irrigation areas at the seasonal scale (WPL = 2.7 and TN = 1.11 mg/L). The prosperity of tourism has led to a tenfold increase in N-related GWFs and a fivefold increase in P-related GWFs for the tourism industry near the Lhasa city. The strict top-down unified management for ecological environmental protection in plateaus may be an effective method.

Impacts of land use and land cover changes on regional climate in the Lhasa River basin, Tibetan Plateau.

Land use and land cover change (LUCC) can alter land surface-atmosphere interactions in the exchange of energy fluxes, with additional consequences on temperature. Understanding the impacts of LUCC on the regional climate contributes to providing fundamental information for future land use planning and regional policy orientation, especially in extremely vulnerable and sensitive plateau regions. This study was designed to explore the regional climate effects associated with LUCC in the Lhasa River basin of Tibetan Plateau using the Weather Research and Forecasting (WRF) model, with a particular focus on near-surface air temperature (Ta) and surface energy fluxes. Two numerical experiments (Case 1980 and Case 2015) were simulated, spanning from November 2014 to November 2015 with the first month as spin-up. The results indicated that the conversion from croplands or grasslands to urban and built-up land led to a noticeable increase in Ta (0.23 °C) during summer. In areas converted from grasslands to waters, Ta decreased by 0.40 °C during spring and approximately 0.50 °C during winter. The afforestation activities at this scale had an obvious impact on the Ta in spring and winter, increasing by 0.20 °C and 0.10 °C, respectively. Generally, the latent heat flux (LE) and sensible heat flux (H) were more sensitive to land conversions, while changes in other fluxes seemed to be weaker. Due to the small change in net radiation (Rn) and ground heat flux (G), the H generally showed an opposite trend with that of LE. Urbanization and reservoir construction resulted in a decrease in the LE, while afforestation construction contributed to an increase in the LE. Our study highlights the impacts of current regional development in the plateau areas on the climate, especially in spring and winter. Urbanization led to a slight warming effect; the cooling effect was more significant in spring and winter than in summer after reservoir construction, and the current afforestation project contributed to a warming effect in winter. This study contributes to the future development of environmentally compatible and sustainable land strategies.

Mechanical assembly of complex, 3D mesostructures from releasable multilayers of advanced materials.

Capabilities for assembly of three-dimensional (3D) micro/nanostructures in advanced materials have important implications across a broad range of application areas, reaching nearly every class of microsystem technology. Approaches that rely on the controlled, compressive buckling of 2D precursors are promising because of their demonstrated compatibility with the most sophisticated planar technologies, where materials include inorganic semiconductors, polymers, metals, and various heterogeneous combinations, spanning length scales from submicrometer to centimeter dimensions. We introduce a set of fabrication techniques and design concepts that bypass certain constraints set by the underlying physics and geometrical properties of the assembly processes associated with the original versions of these methods. In particular, the use of releasable, multilayer 2D precursors provides access to complex 3D topologies, including dense architectures with nested layouts, controlled points of entanglement, and other previously unobtainable layouts. Furthermore, the simultaneous, coordinated assembly of additional structures can enhance the structural stability and drive the motion of extended features in these systems. The resulting 3D mesostructures, demonstrated in a diverse set of more than 40 different examples with feature sizes from micrometers to centimeters, offer unique possibilities in device design. A 3D spiral inductor for near-field communication represents an example where these ideas enable enhanced quality (Q) factors and broader working angles compared to those of conventional 2D counterparts.

Efficient Visible-Light Photocatalytic Properties in Low-Temperature Bi-Nb-O System Photocatalysts.

Low-temperature Bi-Nb-O system photocatalysts were prepared by a citrate method using homemade water-soluble niobium precursors. The structures, morphologies, and optical properties of Bi-Nb-O system photocatalysts with different compositions were investigated deeply. All the Bi-Nb-O powders exhibit appreciably much higher photocatalytic efficiency of photo-degradation of methyl violet (MV), especially for Bi-Nb-O photocatalysts sintered at 750 °C (BNO750), only 1.5 h to completely decompose MV, and the obtained first-order rate constant (k) is 1.94/h. A larger degradation rate of Bi-Nb-O photocatalysts sintered at 550 °C (BNO550) can be attributed to the synergistic effect between ß-BiNbO4 and Bi5Nb3O15. Bi5Nb3O15 with small particle size on ß-BiNbO4 surface can effectively short the diffuse length of electron. BNO750 exhibits the best photocatalytic properties under visible-light irradiation, which can be attributed to its better crystallinity and the synergistic effect between ß-BiNbO4 and α-BiNbO4. The small amount of α-BiNbO4 loading on surface of ß-BiNbO4 can effectively improve the electron and hole segregation and migration. Holes are the main active species of Bi-Nb-O system photocatalysts in aqueous solution under visible-light irradiation.

Battery-free, stretchable optoelectronic systems for wireless optical characterization of the skin.

Recent advances in materials, mechanics, and electronic device design are rapidly establishing the foundations for health monitoring technologies that have "skin-like" properties, with options in chronic (weeks) integration with the epidermis. The resulting capabilities in physiological sensing greatly exceed those possible with conventional hard electronic systems, such as those found in wrist-mounted wearables, because of the intimate skin interface. However, most examples of such emerging classes of devices require batteries and/or hard-wired connections to enable operation. The work reported here introduces active optoelectronic systems that function without batteries and in an entirely wireless mode, with examples in thin, stretchable platforms designed for multiwavelength optical characterization of the skin. Magnetic inductive coupling and near-field communication (NFC) schemes deliver power to multicolored light-emitting diodes and extract digital data from integrated photodetectors in ways that are compatible with standard NFC-enabled platforms, such as smartphones and tablet computers. Examples in the monitoring of heart rate and temporal dynamics of arterial blood flow, in quantifying tissue oxygenation and ultraviolet dosimetry, and in performing four-color spectroscopic evaluation of the skin demonstrate the versatility of these concepts. The results have potential relevance in both hospital care and at-home diagnostics.

Controlled mechanical buckling for origami-inspired construction of 3D microstructures in advanced materials.

Origami is a topic of rapidly growing interest in both the scientific and engineering research communities due to its promising potential in a broad range of applications. Previous assembly approaches of origami structures at the micro/nanoscale are constrained by the applicable classes of materials, topologies and/or capability of control over the transformation. Here, we introduce an approach that exploits controlled mechanical buckling for autonomic origami assembly of 3D structures across material classes from soft polymers to brittle inorganic semiconductors, and length scales from nanometers to centimeters. This approach relies on a spatial variation of thickness in the initial 2D structures as an effective strategy to produce engineered folding creases during the compressive buckling process. The elastic nature of the assembly scheme enables active, deterministic control over intermediate states in the 2D to 3D transformation in a continuous and reversible manner. Demonstrations include a broad set of 3D structures formed through unidirectional, bidirectional, and even hierarchical folding, with examples ranging from half cylindrical columns and fish scales, to cubic boxes, pyramids, starfish, paper fans, skew tooth structures, and to amusing system-level examples of soccer balls, model houses, cars, and multi-floor textured buildings.

Flexible Electronics: Theoretical and Experimental Studies of Epidermal Heat Flux Sensors for Measurements of Core Body Temperature (Adv. Healthcare Mater. 1/2016).

On page 119, J. A. Rogers and co-workers present theoretical approaches, modeling algorithms, materials, and device designs for the noninvasive measurement of core body temperature by using multiple differential temperature sensors that attach softly and intimately onto the surface of the skin. The image shows the construction of differential temperature sensors using thermally insulating foam as the separation material.

Theoretical and Experimental Studies of Epidermal Heat Flux Sensors for Measurements of Core Body Temperature.

Long-term, continuous measurement of core body temperature is of high interest, due to the widespread use of this parameter as a key biomedical signal for clinical judgment and patient management. Traditional approaches rely on devices or instruments in rigid and planar forms, not readily amenable to intimate or conformable integration with soft, curvilinear, time-dynamic, surfaces of the skin. Here, materials and mechanics designs for differential temperature sensors are presented which can attach softly and reversibly onto the skin surface, and also sustain high levels of deformation (e.g., bending, twisting, and stretching). A theoretical approach, together with a modeling algorithm, yields core body temperature from multiple differential measurements from temperature sensors separated by different effective distances from the skin. The sensitivity, accuracy, and response time are analyzed by finite element analyses (FEA) to provide guidelines for relationships between sensor design and performance. Four sets of experiments on multiple devices with different dimensions and under different convection conditions illustrate the key features of the technology and the analysis approach. Finally, results indicate that thermally insulating materials with cellular structures offer advantages in reducing the response time and increasing the accuracy, while improving the mechanics and breathability.

A mechanically driven form of Kirigami as a route to 3D mesostructures in micro/nanomembranes.

Assembly of 3D micro/nanostructures in advanced functional materials has important implications across broad areas of technology. Existing approaches are compatible, however, only with narrow classes of materials and/or 3D geometries. This paper introduces ideas for a form of Kirigami that allows precise, mechanically driven assembly of 3D mesostructures of diverse materials from 2D micro/nanomembranes with strategically designed geometries and patterns of cuts. Theoretical and experimental studies demonstrate applicability of the methods across length scales from macro to nano, in materials ranging from monocrystalline silicon to plastic, with levels of topographical complexity that significantly exceed those that can be achieved using other approaches. A broad set of examples includes 3D silicon mesostructures and hybrid nanomembrane-nanoribbon systems, including heterogeneous combinations with polymers and metals, with critical dimensions that range from 100 nm to 30 mm. A 3D mechanically tunable optical transmission window provides an application example of this Kirigami process, enabled by theoretically guided design.

[Design, synthesis and biological evaluation of novel [1,3] dioxolo [4,5-f]isoindolone derivatives].

A series of [1,3]dioxolo[4,5-f]isoindolone derivatives were designed, synthesized and evaluated as inhibitors of acetylcholinesterases (AChE). Furthermore, their effects on memory impairment of mice induced by scopolamine were investigated with step-through test. The results suggested that most of the target compounds exhibited potential inhibition on AChE with IC50 values at micromolar range. Compounds I1 (IC50 value of 0.086 µmol · L(-1)) and I2 (IC50 value of 0.080 µmol · L(-1)) showed the strongest AChE inhibitory activity, which are equipotent to donepezil (IC50 value of 0.094 µmol · L(-1)). Moreover, compounds I1-I4 could improve the memory impairment induced by scopolamine in mice.

Optics and Nonlinear Buckling Mechanics in Large-Area, Highly Stretchable Arrays of Plasmonic Nanostructures.

Large-scale, dense arrays of plasmonic nanodisks on low-modulus, high-elongation elastomeric substrates represent a class of tunable optical systems, with reversible ability to shift key optical resonances over a range of nearly 600 nm at near-infrared wavelengths. At the most extreme levels of mechanical deformation (strains >100%), nonlinear buckling processes transform initially planar arrays into three-dimensional configurations, in which the nanodisks rotate out of the plane to form linear arrays with "wavy" geometries. Analytical, finite-element, and finite-difference time-domain models capture not only the physics of these buckling processes, including all of the observed modes, but also the quantitative effects of these deformations on the plasmonic responses. The results have relevance to mechanically tunable optical systems, particularly to soft optical sensors that integrate on or in the human body.

Analyses of postbuckling in stretchable arrays of nanostructures for wide-band tunable plasmonics.

Plasmonic nanostructures integrated with soft, elastomeric substrates provide an unusual platform with capabilities in mechanical tuning of key optical properties, where the surface configurations can undergo large, nonlinear transformations. Arrays of planar plasmonic nanodiscs in this context can, for example, transform into three-dimensional (3D) layouts upon application of large levels of stretching to the substrate, thereby creating unique opportunities in wide-band tunable optics and photonic sensors. In this paper, a theoretical model is developed for a plasmonic system that consists of discrete nanodiscs on an elastomeric substrate, establishing the relation between the postbuckling configurations and the applied strain. Analytic solutions of the amplitude and wavelength during postbuckling are obtained for different buckling modes, which agree well with the results of finite-element analyses and experiment measurements. Further analyses show that increasing the nanodisc distribution yields increased 3D configurations with larger amplitudes and smaller wavelengths, given the same level of stretching. This study could serve as a design reference for future optimization of mechanically tunable plasmonic systems in similar layouts.

Effect of pharmaceutical care on medication adherence and hospital admission in patients with chronic obstructive pulmonary disease (COPD): a randomized controlled study.

BACKGROUND: Poor adherence leads to a high rate of exacerbation and poor health-related quality of life (HRQoL) in patients with chronic obstructive pulmonary disease (COPD). However, few strategies are acceptable and effective in improving medication adherence. We investigated whether pharmaceutical care by clinical pharmacists could reinforce medication adherence to reduce exacerbation and improve HRQoL. METHODS: A randomized controlled study was carried out at The First Affiliated Hospital of Guangzhou Medical University from February 2012 to January 2014. Non-adherence patients were randomly assigned to receive pharmaceutical care or to usual care. The pharmaceutical care consisted of individualized education and a series of telephone counseling for 6 months provided by clinical pharmacists. Medication adherence was measured by pill counts plus direct interview at 1- and 6-month pharmaceutical care and one-year follow-up. Severe exacerbations were defined as events that led to hospitalization for acute COPD attack. An interview was conducted to investigate hospital admissions and evaluate severe exacerbations at one-year follow-up. HRQoL was measured by St George's Respiratory Questionnaire at 6 months. RESULTS: At 6-month pharmaceutical care and one-year follow-up, the pharmaceutical care group exhibited higher medication adherence than the usual care group (73.4±11.1 vs. 55.7±11.9, P=0.016 and 54.4±12.5 vs. 66.5±8.6, P=0.039, respectively). There are 60 acute exacerbations resulted in a hospital admission in the usual group while 37 ones in the pharmaceutical care group during one-year follow-up (P=0.01). Hospital admissions due to acute exacerbation in the pharmaceutical care group were 56.3% less than the usual care group (P=0.01). There was a significant difference in the symptoms and impact subscales respectively at 6-month pharmaceutical care between two groups (P=0.032, P=0.018). CONCLUSIONS: Individualized pharmaceutical care improved medication adherence, reduced hospitalization and elevated HRQoL in patients with COPD.

[Roles of bile and gastrin in the pathogenesis of childhood gastroesophageal reflux disease].

OBJECTIVE: To explore the incidence of acid and bile reflux in children with gastroesophageal reflux disease (GERD) and to study the roles of bile and gastrin in the pathogenesis of childhood GERD. METHODS: Forty-two cases of GERD were divided into two groups according to endoscopic findings: reflux esophagitis (RE) and non-erosive reflux disease (NERD). The patients underwent 24-hr ambulatory esophageal pH and bilirubin monitoring. The serum concentration of gastrin was detected by radioimmunoassay. Thirteen children without gastroesophageal reflux symptoms, digestive tract disease and severe systemic organic disease served as the Control group. RESULTS: Of the 42 cases of GERD, 24 cases were confirmed with RE, with esophageal mucosal lesions, and 18 were NERD without esophageal mucosal lesions by endoscopy. Both acid and bile reflux parameters, including the percentage of total time with pH < 4 and bilirubin absorbance >/= 0.14, the total number of reflux episodes and the number of bile reflux episodes lasting longer than 5 minutes, were significantly higher in the GERD patients than those in the Control group (P < 0.05). The time of esophageal acid exposure (pH < 4) and the percentage of total time with bilirubin absorbance >/= 0.14 increased significantly in the RE group compared with in the NERD group (P < 0.05). Sixteen RE patients had a mixed reflux of bile and acid (66.7%) but only 6 NERD patients (33.3%) had (P < 0.01). The serum concentration of gastrin in the RE group (125.12 +/- 45.06 pg/mL) and the NERD group (98.22 +/- 27.92 pg/mL) was significantly higher than that of the Control group (74.22 +/- 20.34 pg/mL) (P < 0.01, P < 0.05 respectively). A significant difference was noted in the serum concentration of gastrin between the RE and the NERD groups (P < 0.05). CONCLUSIONS: Mixed reflux of bile and acid are common in children with GERD. Bile reflux may play a role in the development of GERD. Gastrin parasecretion may participate in the development of GERD. Gastrin and bile reflux may have synergistic effects on the development of childhood GERD.