Masked Modeling-Based Ultrasound Image Classification via Self-Supervised Learning.

Recently, deep learning-based methods have emerged as the preferred approach for ultrasound data analysis. However, these methods often require large-scale annotated datasets for training deep models, which are not readily available in practical scenarios. Additionally, the presence of speckle noise and other imaging artifacts can introduce numerous hard examples for ultrasound data classification. In this paper, drawing inspiration from self-supervised learning techniques, we present a pre-training method based on mask modeling specifically designed for ultrasound data. Our study investigates three different mask modeling strategies: random masking, vertical masking, and horizontal masking. By employing these strategies, our pre-training approach aims to predict the masked portion of the ultrasound images. Notably, our method does not rely on externally labeled data, allowing us to extract representative features without the need for human annotation. Consequently, we can leverage unlabeled datasets for pre-training. Furthermore, to address the challenges posed by hard samples in ultrasound data, we propose a novel hard sample mining strategy. To evaluate the effectiveness of our proposed method, we conduct experiments on two datasets. The experimental results demonstrate that our approach outperforms other state-of-the-art methods in ultrasound image classification. This indicates the superiority of our pre-training method and its ability to extract discriminative features from ultrasound data, even in the presence of hard examples.

The effectiveness of a virtual reality teaching module on advance care planning and advance decision for medical professionals.

BACKGROUND: The concepts of advance care planning (ACP) and advance decisions/directives (ADs) are widely recognized around the world. The Patient Right to Autonomy Act in Taiwan, the first of its kind in Asia, went into effect in 2019. However, a lack of knowledge and confidence regarding ACP and ADs is a barrier for medical professionals in discussing ACP and ADs with their patients. In addition, in Asian countries, physicians tend to make family-centered decisions, which influence how they can implement ADs. METHODS: Virtual reality (VR) is known for its immersive and interactive simulation experience and can upgrade medical education. We developed a VR teaching module to help medical professionals better understand ACP and ADs, with assessment tools integrated into the module. The participants were asked to answer seven knowledge items embedded in the module and fill out the surveys regarding attitudes toward ACP and ADs and confidence in implementing ADs before and after the module. They also reported behaviors related to ADs before and three months after the VR experience. RESULTS: From July 2020 to June 2022, 30 physicians and 59 nurses joined the study, and 78.7% of them had no prior experience in hospice care. After learning from the VR module, all 89 participants were able to answer all seven items correctly. The results showed a slightly more positive attitude toward ACP and ADs (scores: 32.29 ± 3.80 versus 33.06 ± 3.96, p < .05) and more confidence in implementing ADs (scores: 13.96 ± 2.68 versus 16.24 ± 2.67, p < .001) after the VR module. Changes in AD-related behaviors (scores: 11.23 ± 4.01 versus 13.87 ± 4.11, p < .001) were also noted three months after the VR experience. CONCLUSIONS: This study found that medical professionals may have better knowledge of ACP and ADs, slightly improved attitudes toward ACP and ADs, and greater confidence in implementing ADs after experiencing the VR module. Most importantly, the findings suggested that using a VR format may help motivate medical professionals to perform essential behaviors related to ADs, including introducing ADs to their patients and discussing ADs with their own family.

Self-supervised learning-based underwater acoustical signal classification via mask modeling.

The classification of underwater acoustic signals has garnered a great deal of attention in recent years due to its potential applications in military and civilian contexts. While deep neural networks have emerged as the preferred method for this task, the representation of the signals plays a crucial role in determining the performance of the classification. However, the representation of underwater acoustic signals remains an under-explored area. In addition, the annotation of large-scale datasets for the training of deep networks is a challenging and expensive task. To tackle these challenges, we propose a novel self-supervised representation learning method for underwater acoustic signal classification. Our approach consists of two stages: a pretext learning stage using unlabeled data and a downstream fine-tuning stage using a small amount of labeled data. The pretext learning stage involves randomly masking the log Mel spectrogram and reconstructing the masked part using the Swin Transformer architecture. This allows us to learn a general representation of the acoustic signal. Our method achieves a classification accuracy of 80.22% on the DeepShip dataset, outperforming or matching previous competitive methods. Furthermore, our classification method demonstrates good performance in low signal-to-noise ratio or few-shot settings.

Stannate-Based Materials as Anodes in Lithium-Ion and Sodium-Ion Batteries: A Review.

Binary metal oxide stannate (M2SnO4; M = Zn, Mn, Co, etc.) structures, with their high theoretical capacity, superior lithium storage mechanism and suitable operating voltage, as well as their dual suitability for lithium-ion batteries (LIBs) and sodium-ion batteries (SIBs), are strong candidates for next-generation anode materials. However, the capacity deterioration caused by the severe volume expansion problem during the insertion/extraction of lithium or sodium ions during cycling of M2SnO4-based anode materials is difficult to avoid, which greatly affects their practical applications. Strategies often employed by researchers to address this problem include nanosizing the material size, designing suitable structures, doping with carbon materials and heteroatoms, metal-organic framework (MOF) derivation and constructing heterostructures. In this paper, the advantages and issues of M2SnO4-based materials are analyzed, and the strategies to solve the issues are discussed in order to promote the theoretical work and practical application of M2SnO4-based anode materials.

Jackknife model averaging for high-dimensional quantile regression.

In this paper, we propose a frequentist model averaging method for quantile regression with high-dimensional covariates. Although research on these subjects has proliferated as separate approaches, no study has considered them in conjunction. Our method entails reducing the covariate dimensions through ranking the covariates based on marginal quantile utilities. The second step of our method implements model averaging on the models containing the covariates that survive the screening of the first step. We use a delete-one cross-validation method to select the model weights, and prove that the resultant estimator possesses an optimal asymptotic property uniformly over any compact (0,1) subset of the quantile indices. Our proof, which relies on empirical process theory, is arguably more challenging than proofs of similar results in other contexts owing to the high-dimensional nature of the problem and our relaxation of the conventional assumption of the weights summing to one. Our investigation of finite-sample performance demonstrates that the proposed method exhibits very favorable properties compared to the least absolute shrinkage and selection operator (LASSO) and smoothly clipped absolute deviation (SCAD) penalized regression methods. The method is applied to a microarray gene expression data set.

Targeted Next-Generation Sequencing-Based Multiple Gene Mutation Profiling of Patients with Rectal Adenocarcinoma Receiving or Not Receiving Neoadjuvant Chemoradiotherapy.

This study investigated whether oncogenic and tumor-suppressive gene mutations are involved in the differential outcomes of patients with rectal carcinoma receiving neoadjuvant chemoradiotherapy (nCRT). Genomic DNA was obtained from formalin-fixed paraffin-embedded (FFPE) specimens of patients with rectal carcinoma who received a complete nCRT course. Gene mutation status was examined in specimens from patients before and after nCRT by using the AmpliSeq platform. Our data revealed that the nonsynonymous p53, APC, KRAS, CDKN2A, and EGFR mutations were observed in 93.1%, 65.5%, 48.6%, and 31% of the patients with rectal adenocarcinoma, respectively. BRAF, FBXW7, PTEN, and SMAD4 mutations were observed in 20.7% of patients with rectal carcinoma. The following 12 gene mutations were observed more frequently in the patients exhibiting a complete response than in those demonstrating a poor response before nCRT: ATM, BRAF, CDKN2A, EGFR, FLT3, GNA11, KDR, KIT, PIK3CA, PTEN, PTPN11, SMAD4, and TP53. In addition, APC, BRAF, FBXW7, KRAS, SMAD4, and TP53 mutations were retained after nCRT. Our results indicate a complex mutational profile in rectal carcinoma, suggesting the involvement of BRAF, SMAD4, and TP53 genetic variants in the outcomes of patients with nCRT.

Dynamic hybrid-phase computed tomography simulation in lung stereotactic body radiotherapy: A feasibility study.

To assess the feasibility of dynamic hybrid-phase computed tomography (CTDHP) simulation when patients undergo lung stereotactic body radiation therapy (SBRT). Eighteen non-small-cell lung-cancer patients were immobilised in a stereotactic body frame with abdominal compression. All underwent dynamic hybrid-phase CT scans that were compared with cone-beam CT (CBCT). We also determined the internal target volume (ITV) and evaluated the following four metrics: the "AND" function in the Boolean module of Eclipse, volume overlap (VO), Dice similarity coefficient (DSC), and dose-volume histogram. The average ITV values of 4DCTDHP and 3D-CBCT were respectively 12.82±10.42 and 14.6±12.18 cm3 (n=72, p<0.001), and the average ITV value of AND was 11.7±10.1 cm3. The average planning target volume (PTV) of 4DCTDHP and 3D-CBCT was 25.63±18.04 and 28.00±19.82 cm3 (n=72, p<0.001). The median AND difference between ITV and PTV was significant (p<0.01) and had a significantly linear distribution (R2=0.991 for ITV, R2=0.972 for PTV). The average VO of PTV was greater than that of ITV (0.81±0.096; 0.78±0.11). We also observed that the average DSC in PTV (0.83±0.066) was greater than that in ITV (0.81±0.084). The average results indicated that 97.9%±3.44 of ITVCBCT was covered by 95% of the prescribed dose. The average minimum, maximum and mean percentage doses of ITVCBCT were 87.9%±9.46, 107.3%±1.57, and 101.3%±1.12, respectively. This paper has demonstrated that dynamic hybrid-phase CT simulation for patients undergoing lung SBRT and also published evaluation metrics in scientific analysis. Our approach also has the advantage of adequate margin and fewer phases in CT simulation.

Evaluating the benefit of adjuvant radiotherapy after extensive lymph node dissection for gastric cancer: a single-institute retrospective study.

OBJECTIVE: This study aimed to evaluate whether adjuvant radiotherapy (RT) can improve the treatment outcome of patients with locally advanced gastric cancer who underwent extensive lymph node dissection (ELND). MATERIALS AND METHODS: This retrospective study included patients with gastric cancer pathological stages IIA-IIIC at Taipei Tzu Chi Hospital between 2008 and 2015. Patients (a) aged >80 years, (b) with distant metastasis at diagnosis, (c) with coexisting malignancies, (d) who did not complete the prescribed RT course, and (e) who died 1 month after surgery were excluded. Among 420 patients diagnosed with gastric cancer, 98 were included. RESULTS: The median follow-up was 24.5 months. Of 39 patients who underwent adjuvant RT, 38 also received adjuvant chemotherapy (CT). Of 59 patients who did not receive adjuvant RT, only 34 received adjuvant CT. ELND was performed in 67.3% of the patients. The 5-year overall survival (OS) rate was 40%. In the univariate analyses, adjuvant CT regimen, 5-fluorouracil + leucovorin, was associated with worst outcome, while TS-1 was associated with better survival outcome (P = 0.018). The number of involved lymph nodes was strongly related to the OS and disease-free survival (DFS) (P < 0.001). We tried using different numbers of involved lymph nodes as a cutoff point and found that adjuvant RT significantly improved both OS and DFS in patients whose involved lymph nodes were ≥4 (OS, P = 0.017; DFS, P = 0.015). In multivariate analyses, better DFS was associated with negative surgical margin (P = 0.04), earlier disease stage (P = 0.001), adjuvant radiotherapy (P = 0.045), and adjuvant CT regimen TS-1 (P = 0.001). CONCLUSION: Adjuvant RT could improve DFS of patients with locally advanced gastric cancer with or without ELND. When the number of involved lymph nodes is ≥4, adjuvant RT is strongly suggested.

Use of electronic portal images to evaluate setup error and intra-fraction motion during free-breathing breast IMRT treatment.

Before delivering of intensity-modulated radiotherapy, kilo-voltage image-guidance radiotherapy is widely used in setup error correction and monitoring intra-fraction motion effectively. Accordingly, this study proposes and tests an image integration technique for observing intra-fraction motion during beam delivery, with the wider objective of reducing both image-guidance time and the dose delivered to normal breast tissue. The study sample comprised 33 female patients with breast cancer, and 241 sets of portal images acquired using a VARIAN aSi-1000 electronic portal imaging device. Motion amplitudes and vectors were collected and calculated separately by two senior therapists. The setup error in 3 axes was computed for every fraction, with average shifting for lateral, longitudinal and vertical direction was -0.3-mm ± 0.5, -0.1-mm ± 0.5 and -0.6-mm ± 1.6, with the average vector of setup error being 2.9-mm ± 1.4. The average intra-fraction motion for vertical direction was (A: -0.1-mm ± 1.0; B: -0.0 ± 1.1), for longitudinal was (A: -0.4-mm ± 1.7; B: 2.0 ± 1.1), and for lateral direction was (A: 0.3-mm ± 1.3; B: 0.2 ± 1.8). The average intra-fraction vector was 2.9-mm ± 1.3 for therapist A, and 3.4-mm ± 1.8 for therapist B. Offline Review commercial software was utilized for setup error and motion analysis, and data analysis and reliability testing were conducted with statistical package of the social sciences. Pearson correlations between the two therapists was moderate (0.59, p << 0.01), and the Cohen's kappa value for inter rater agreement between different evaluators was fair in the anterior-posterior direction (0.25, p << 0.01), with slight agreement in other two directions and vectors. The study presented efficient and dose reduction method to evaluate setup error and intra-fraction motion during breast intensity-modulated radiotherapy treatment.

Competing endogenous RNA analysis reveals the regulatory potency of circRNA_036186 in HNSCC.

This study aimed to characterize circular RNA (circRNA) expression profiles and biological functions in head and neck squamous cell carcinoma (HNSCC). Differentially expressed circRNAs were screened using an Arraystar Human CircRNA Array and verified by reverse transcription-quantitative polymerase chain reaction. Multiple bioinformatics methods and a hypergeometric test were employed to predict the interactions between RNAs and the functional circRNA­microRNA (miRNA)-mRNA axes in HNSCC. As a result, 287 circRNAs and 1,053 mRNAs were determined to be differentially expressed in HNSCC compared with the adjacent tissue. In addition, the expression levels of circRNA_036186 and tyrosine 3-monooxygenase/tryptophan 5-monooxygenase activation protein, ζ polypeptide (14­3­3ζ) were identified to be significantly different. A competing endogenous RNA (ceRNA) network was constructed, consisting of 5 circRNAs, 385 miRNAs and 96 mRNAs. Furthermore, we predicted that miR­193b­3p exerts a significant effect on 14­3­3ζ, and was significantly associated with the Hippo signaling pathway in HNSCC. On the whole, these findings suggest that circRNA_036186 likely regulates 14­3­3ζ expression by functioning as a ceRNA in the development and progression of HNSCC.

Is quality of registry treatment data related to registrar experience and workload? A study of Taiwan cancer registry data.

BACKGROUND: Although cancer treatment information has been collected through the Cancer Registry system in Taiwan for more than 10 years, the accuracy of such data has never been evaluated. This study examined the accuracy rate between registrar experience and on-site chart review for the first course of cancer treatment. METHODS: In this retrospective chart review study, 392 randomly selected medical records from 14 hospitals were re-abstracted by experienced abstractors. The kappa coefficients of accuracy for the abstracting data were calculated against the gold standard. Correlations between registrar background and workload were then identified through regression analysis. RESULTS: Regarding surgery type, low accuracy rates were noted for gastric cancer (84.0%), oral cavity cancer (84.6%), and bladder cancer (88.9%). For chemotherapy, low accuracy rates were observed for hematopoietic diseases (81.3%) and esophageal cancer (88.0%). For radiotherapy, low accuracy rates were noted for esophageal cancer (80.0%), cervical cancer (81.8%), and lymphoma (85.7%). When stratifying by surgery type after adjustment for hospital caseload, a high accuracy rate was found for cancer registrars who had progressed from basic to advanced licenses within 5 years of graduating. CONCLUSION: The accuracy rate for the first course of cancer treatment was affected by the cancer type and the experience of cancer registrars, but it was not affected by the workload of cancer registrars. We recommend that cancer registrars with basic licenses upgrade to advanced licenses as soon as possible. Medical record collaboration should establish documentation for checklist of radiotherapy and surgical operation records.

Safety and Efficacy of the Endeavor Resolute® Stent in Patients with Multivessel Disease: The HEART (Honam EndeAvor ResoluTe) Prospective, Multicenter Trial / 전남의대학술지

The Endeavor Resolute® (ER) is a zotarolimus-eluting stent (ZES) with a biocompatible BioLinx polymer. This study prospectively compared the clinical outcomes of 2 versions of ZES, ER and Endeavor Sprint® (ES), in patients with multivessel disease. A total of 488 patients who underwent multivessel percutaneous coronary intervention (PCI) were divided into 2 groups the ER group (n=288) and the ES group (n=200). The primary endpoint was a composite of major adverse cardiac events (MACE) consisting of death, myocardial infarction, and target vessel revascularization after 12 months. In all patients, the prevalence of diabetes was higher in the ER group (42.7% vs. 31.0%, p=0.009). The rate of post-PCI Thrombolysis in Myocardial Infarction flow grade 3 was higher in the ER group (100.0% vs. 98.0%, p=0.028). There were no between-group differences in the in-hospital, 1-month and 12-month clinical outcomes. In the propensity score matched cohort (n=200 in each group), no differences were observed in the baseline and procedural characteristics. There were no statistical differences in the rates of in-hospital, 1-month and 12-month events (12-month MACE in the ER and ES groups: 6.0% vs. 3.5%, p=0.240, respectively). The safety and efficacy of both versions of ZES were comparable in patients with multivessel disease during a 12-month clinical follow-up.

Randomized, Double-blind, Placebo-controlled Clinical Trial for the Evaluation of the Efficacy and Safety of Artemisia and Green Tea Extract SD1003F in Volunteers with Helicobacter pylori-associated Gastric Discomfort

BACKGROUND/AIMS: A previous study showed that dietary intervention with Artemisia and green tea extracts, i.e., SD1003F, relieved Helicobacter pylori-associated chronic atrophic gastritis in a mouse model. We continue the research through the current randomized double-blind clinical trial to evaluate the efficacy and safety of the intervention for H. pylori-associated gastric discomfort. MATERIALS AND METHODS: Forty-nine volunteers who tested positive for H. pylori infection received either placebo or SD1003F for 10 weeks and their functional dyspepsia-related quality of life (QOL) was evaluated. H. pylori infection using a urea breath test (UBT), measurement of pepsinogen level using GastroPanel. Adverse effects with biochemical changes were also evaluated. RESULTS: SD1003F administration significantly improved health related-QOL, including dietary intake, emotional stability, life pattern, and social factors relevant to gastric discomfort, in comparison to the control (P < 0.05). The mean UBT measurement significantly decreased in the SD1003F group (P < 0.05). In 2 of the 24 volunteers, SD1003F alone eradicated H. pylori infection, with significant improvements in endoscopic findings. GastroPanel analysis revealed significant improvements that reflect rejuvenation of gastric atrophy in the SD1003F group. No significant side effect was observed in any participant. CONCLUSIONS: SD1003F (Artemisia and green tea extract), is a potential phytochemical to improve H. pylori-associated gastric discomfort.

Elemental sulfur recovery and spatial distribution of functional bacteria and expressed genes under different carbon/nitrate/sulfide loadings in up-flow anaerobic sludge blanket reactors.

To characterize the impact of influent loading on elemental sulfur (S0) recovery during the denitrifying and sulfide oxidation process, three identical, lab-scale UASB reactors (30cm in length) were established in parallel under different influent acetate/nitrate/sulfide loadings, and the reactor performance and functional community structure were investigated. The highest S0 recovery was achieved at 77.9% when the acetate/nitrate/sulfide loading was set to 1.9/1.6/0.7kgd-1m-3. Under this condition, the genera Thauera, Sulfurimonas, and Azoarcus were predominant at 0-30, 0-10 and 20-30cm, respectively; meanwhile, the sqr gene was highly expressed at 0-30cm. However, as the influent loading was halved and doubled, S0 recovery was decreased to 27.9% and 45.1%, respectively. As the loading was halved, the bacterial distribution became heterogeneous, and certain autotrophic sulfide oxidation genera, such as Thiobacillus, dominated, especially at 20-30cm. As the loading doubled, the bacterial distribution was relatively homogeneous with Thauera and Azoarcus being predominant, and the nirK and sox genes were highly expressed. The study verified the importance of influent loading to regulate S0 recovery, which could be achieved as Thauera and Sulfurimonas dominated. An influent loading that was too low or too high gave rise to insufficient oxidation or over-oxidation of the sulfide and low S0 recovery performance.

Haptoglobin is a serological biomarker for adenocarcinoma lung cancer by using the ProteomeLab PF2D combined with mass spectrometry.

Identification of serological biomarker is urgently needed for cancer screening, monitoring cancer progression, treatment response, and surveillance for recurrence in lung cancer. Therefore, we try to find new serological biomarker that has more specificity and sensitivity for lung cancer diagnostics. In this study, the 2-D liquid phase fractionation system (PF2D) and mass spectrometry approach has been used for comparison the serum profiles between lung cancer patients and healthy individuals. Eight proteins were identified form PF2D and subsequently by mass spectrometry. Among these proteins, haptoglobin (HP) and apolipoprotein AI (APOA1) were chosen and validated with turbidimetric assay. We found that HP levels were significantly higher and APOA1 levels were significantly lower in lung cancer patients. However, after the participants were stratified by gender, the expression trends of HP and APOA1 in lung cancer patients existed only in men, which is gender specific phenomenon. HP, APOA1 and carcinoembryonic antigen (CEA), used for distinguishing lung adenocarcinoma, had a sensitivity of 64%, 64% and 79%, respectively. Area under the ROC curve (AUC) of HP, APOA1 and CEA were 0.768, 0.761 and 0.884, respectively. When restricted to male subjects, HP, APOA1 and CEA showed sensitivity of 89%, 73% and 100%, respectively. AUC of HP, APOA1 and CEA were 0.929, 0.840 and 0.877, respectively. Therefore, our results showed that combined with PF2D system and mass spectrometry, this is a promising novel approach to identify new serological biomarkers for lung cancer research. In addition, HP may be a potential serological biomarker for lung adenocarcinoma diagnostics, especially in male subjects.

Optimal technique of linear accelerator-based stereotactic radiosurgery for tumors adjacent to brainstem.

Stereotactic radiosurgery (SRS) is a well-established technique that is replacing whole-brain irradiation in the treatment of intracranial lesions, which leads to better preservation of brain functions, and therefore a better quality of life for the patient. There are several available forms of linear accelerator (LINAC)-based SRS, and the goal of the present study is to identify which of these techniques is best (as evaluated by dosimetric outcomes statistically) when the target is located adjacent to brainstem. We collected the records of 17 patients with lesions close to the brainstem who had previously been treated with single-fraction radiosurgery. In all, 5 different lesion catalogs were collected, and the patients were divided into 2 distance groups-1 consisting of 7 patients with a target-to-brainstem distance of less than 0.5cm, and the other of 10 patients with a target-to-brainstem distance of ≥ 0.5 and < 1cm. Comparison was then made among the following 3 types of LINAC-based radiosurgery: dynamic conformal arcs (DCA), intensity-modulated radiosurgery (IMRS), and volumetric modulated arc radiotherapy (VMAT). All techniques included multiple noncoplanar beams or arcs with or without intensity-modulated delivery. The volume of gross tumor volume (GTV) ranged from 0.2cm(3) to 21.9cm(3). Regarding the dose homogeneity index (HIICRU) and conformity index (CIICRU) were without significant difference between techniques statistically. However, the average CIICRU = 1.09 ± 0.56 achieved by VMAT was the best of the 3 techniques. Moreover, notable improvement in gradient index (GI) was observed when VMAT was used (0.74 ± 0.13), and this result was significantly better than those achieved by the 2 other techniques (p < 0.05). For V4Gy of brainstem, both VMAT (2.5%) and IMRS (2.7%) were significantly lower than DCA (4.9%), both at the p < 0.05 level. Regarding V2Gy of normal brain, VMAT plans had attained 6.4 ± 5%; this was significantly better (p < 0.05) than either DCA or IMRS plans, at 9.2 ± 7% and 8.2 ± 6%, respectively. Owing to the multiple arc or beam planning designs of IMRS and VMAT, both of these techniques required higher MU delivery than DCA, with the averages being twice as high (p < 0.05). If linear accelerator is only 1 modality can to establish for SRS treatment. Based on statistical evidence retrospectively, we recommend VMAT as the optimal technique for delivering treatment to tumors adjacent to brainstem.

Efficient regulation of elemental sulfur recovery through optimizing working height of upflow anaerobic sludge blanket reactor during denitrifying sulfide removal process.

In this study, two lab-scale UASB reactors were established to testify S(0) recovery efficiency, and one of which (M-UASB) was improved from the previous T-UASB by shortening reactor height once S(2-) over oxidation was observed. After the height was shortened from 60 to 30cm, S(0) recovery rate was improved from 7.4% to 78.8%, and while, complete removal of acetate, nitrate and S(2-) was simultaneously maintained. Meanwhile, bacterial community distribution was homogenous throughout the reactor, with denitrifying sulfide oxidization bacteria predominant, such as Thauera and Azoarcus spp., indicating the optimized condition for S(0) recovery. The effective control of working height/volume in reactors plays important roles for the efficient regulation of S(0) recovery during DSR process.

Microbial community structure and function in response to the shift of sulfide/nitrate loading ratio during the denitrifying sulfide removal process.

Influence of acetate-C/NO3(-)-N/S(2-) ratio to the functional microbial community during the denitrifying sulfide removal process is poorly understood. Here, phylogenetic and functional bacterial community for elemental sulfur (S(0)) recovery and nitrate (NO3(-)) removal were investigated with the switched S(2-)/NO3(-) molar ratio ranged from 5/2 to 5/9. Optimized S(2-)/NO3(-) ratio was evaluated as 5/6, with the bacterial genera predominated with Thauera, Enterobacter, Thiobacillus and Stappia, and the sqr gene highly expressed. However, insufficient or high loading of acetate and NO3(-) resulted in the low S(0) recovery, and also significantly modified the bacterial community and genetic activity. With S(2-)/NO3(-) ratio of 5/2, autotrophic S(2-) oxidization genera were dominated and NO3(-) reduction activity was low, confirmed by the low expressed nirK gene. In contrast, S(2-)/NO3(-) ratio switched to 5/8 and 5/9 introduced diverse heterotrophic nitrate reduction and S(0) over oxidization genera in accompanied with the highly expressed nirK and sox genes.

[Hereditary fibrinogen Aα-chain amyloidosis caused by the E526V mutation: a case report and literature review].

Mutations in the fibrinogen Aα-chain genes are the most common cause of hereditary renal amyloidosis. The renal histologic appearance in the patient is characteristic and shows striking glomerular enlargement with almost complete obliteration of the normal glomerular architecture by extensive amyloid deposition. In contrast, the vessels and renal tubular interstitium of such patient contains almost no amyloid at all. Here, we described a patient with hereditary fibrinogen amyloidosis, who presented with proteinuria, hypertension and renal failure. He was shown to be heterozygous for the relevant mutation encoding the E526V fibrinogen variant.

Acquired Fanconi syndrome with proximal tubular cytoplasmic fibrillary inclusions of λ light chain restriction.

Light chain proximal tubulopathy is a rarely reported entity associated with plasma cell dyscrasia that classically manifests as acquired Fanconi syndrome and is characterized by the presence of κ-restricted crystals in the proximal tubular cytoplasm. We herein present a case of multiple myeloma with Fanconi syndrome and acute kidney injury due to light chain proximal tubulopathy with light chain cast nephropathy. Prominent phagolysosomes and numerous irregularly shaped inclusions with a fibrillary matrix in the cytoplasm of the proximal tubules were identified on electron microscopy. A monotypic light chain of the λ type was detected in the distal tubular casts, proximal tubular cytoplasmic lysosomes and fibrillary inclusions on immunofluorescence and immune electron microscopy. This case underscores the importance of conducting careful ultrastructural investigations and immunocytologic examinations of light chains for detecting and diagnosing light chain proximal tubulopathy.