Left Ventricular Pressure Strain Loops for Evaluation of Myocardial Work in Type 2 Diabetic Patients with Hypertension.

BACKGROUND: Type 2 diabetes mellitus (T2DM) and hypertension (HT) are the two most common underlying diseases worldwide, and they often coexist. The long-term existence of both may lead to left ventricular dysfunction. Therefore, evaluating the cardiac function of T2DM patients with HT is vital to guide treatment and improve prognosis. Left ventricular pressure strain loops (LVPSL) combine left ventricular strain and afterload, which can quantify left ventricular energy expenditure and detect left ventricular subclinical systolic dysfunction. Many studies have focused on myocardial work (MW) in uncomplicated T2DM patients or simple HT patients, but a few have focused on T2DM patients with HT. OBJECTIVE: The study aimed to evaluate the MW changes in T2DM patients with HT using LVPSL and to find independent related factors of MW parameters. METHODS: 40 T2DM patients, 35 HT patients, 40 T2DM patients with HT (T2DM+HT group), and 35 controls were enrolled. The differences between clinical data, conventional ultrasound parameters, and MW parameters were analyzed among the four groups. RESULTS: The global longitudinal strain (GLS) of the T2DM group, HT group, and T2DM+HT group was lower than the control group (P<0.05). The global work index (GWI) and global constructive work (GCW) in the T2DM group were lower than other groups (P<0.05). The GWI of the HT group was higher than other groups (P<0.05), while GCW was only higher than the T2DM group and T2DM+HT group (P<0.05). The GWI and GCW of the T2DM+HT group were higher than the T2DM group and were lower than the HT group(P<0.05), while there was no significant difference with the control group. HT group and T2DM+HT group had higher global work waste (GWW) (P<0.05). The global work efficiency (GWE) of the T2DM+HT group was lower than other groups (P<0.05). Systolic blood pressure (SBP) and glycosylated hemoglobin (HbA1c) were independent factors of each MW parameter. CONCLUSION: LVPSL can recognize left ventricular subclinical systolic dysfunction early in patients with T2DM and HT. Compared to simple T2DM or HT, the combination of T2DM and HT had greater damage to left ventricular systolic function. SBP and HbA1c are two factors that have a considerable impact on MW parameters. The impact of afterload on MW parameters should be paid more attention to.

Successful treatment with osimertinib for nonmucinous bronchioloalveolar carcinoma with massive bronchorrhea and respiratory failure: a case report and literature review.

Background: Correct diagnosis of bronchioloalveolar carcinoma (BAC) is often delayed due to the lack of familiarity with the condition among clinicians as its sporadic nature and its symptoms are similar to other respiratory issues. Among these, acute respiratory failure (ARF) caused by massive bronchorrhea is rarely associated with BAC. Here we first reported osimertinib in the treatment of BAC with bronchorrhea and ARF. Case Description: A 38-year-old woman presented with massive bronchorrhea and progressive dyspnea. A chest computed tomography (CT) scan showed consolidation with air bronchograms and multiple nodules in both lungs. The patient had no history of chronic pulmonary disease, diabetes mellitus, hypertension or smoke. The patient was initially diagnosed with pneumonia, but ARF developed despite the antibiotic therapy provided. Lung biopsy results revealed nonmucinous BAC. Osimertinib (80 mg daily) was prescribed and proved effective for the first time with an improved ARF and a decreased multiple nodules or consolidation in the lungs during the follow-up period. Conclusions: It is important for physicians to recognize the typical symptoms and radiological manifestations of BAC to avoid misdiagnosis or late diagnosis. This is especially important since early diagnosis allows for immediate epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) therapy, which is a potentially beneficial treatment for patients with BAC.

Application of Contrast-enhanced Ultrasound and Bosniak Classification to the Diagnosis of Cystic Renal Masses.

BACKGROUND: The Bosniak classification system based on contrast-enhanced computed tomography (CECT) is commonly used for the differential diagnosis of cystic renal masses. Contrastenhanced ultrasound (CEUS) is a relatively novel technique, which has gradually played an important role in the diagnosis of cystic renal cell carcinoma (CRCC) due to its safety and lowest price. OBJECTIVE: The aim of the study is to investigate the application value of CEUS and Bosniak classification into the diagnosis of cystic renal masses. METHODS: 32 cystic masses from January 2018 to December 2019 were selected. The images of conventional ultrasound (US), CEUS and CECT from subjects confirmed by surgical pathology were retrospectively analyzed. The Bosniak classification system of cystic renal masses was implemented using CEUS and CECT, and the diagnostic ability was compared. RESULTS: For the 32 cystic masses, postoperative pathology confirmed 11 cases of multilocular CRCC, 15 cases of clear cell carcinoma with hemorrhage, necrosis and cystic degeneration, 5 cases of renal cysts, and 1 case of renal tuberculosis. The Bosniak classification based on CEUS was higher than that based on CECT, and the difference was statistically significant (P = .024). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CEUS were comparable to CECT. There was no significant difference observed in the diagnosis of CRCC (P >.05). CONCLUSION: CEUS combined with Bosniak classification greatly improves the diagnosis of CRCC. CEUS shows a comparable diagnostic ability to CECT. In daily clinical routine, patients who require multiple examinations and present contraindications for CECT can particularly benefit from CEUS.

Hierarchically Hybrid Porous Co3O4@NiMoO4/CoMoO4 Heterostructures for High-Performance Electrochemical Energy Storage.

Hierarchical, ultrathin, and porous NiMoO4@CoMoO4 on Co3O4 hollow bones were successfully designed and synthesized by a hydrothermal route from the Co-precursor, followed by a KOH (potassium hydroxide) activation process. The hydrothermally synthesized Co3O4 nanowires act as the scaffold for anchoring the NiMoO4@CoMoO4 units but also show more compatibility with NiMoO4, leading to high conductivity in the heterojunction. The intriguing morphological features endow the hierarchical Co3O4@NiMoO4@CoMoO4 better electrochemical performance where the capacity of the Co3O4@NiMoO4@CoMoO4 heterojunction being 272 mA·h·g-1 at 1 A·g-1 can be achieved with a superior retention of 84.5% over 1000 cycles. The enhanced utilization of single/few NiMoO4@CoMoO4 shell layers on the Co3O4 core make it easy to accept extra electrons, enhancing the adsorption of OH- at the shell surface, which contribute to the high capacity. In our work, an asymmetric supercapacitor utilizing the optimized Co3O4@NiMoO4@CoMoO4 activated carbon (AC) as electrode materials was assembled, namely, Co3O4@NiMoO4@CoMoO4//AC device, yielding a maximum high energy density of 53.9 W·h·kg-1 at 1000 W·kg-1. It can retain 25.92 W·h·kg-1 even at 8100 W·kg-1, revealing its potential and viability for applications. The good power densities are ascribed to the porous feature from the robust architecture with recreated abundant mesopores on the composite, which assure improved conductivity and enhanced diffusion of OH- and also the electron transport. The work demonstrated here holds great promise for synthesizing other heterojunction materials M3O4@MMoO4@MMoO4 (M = Fe, Ni, Sn, etc).

Antineutrophil cytoplasmic antibody-associated vasculitis with alveolar hemorrhage and ruptured renal aneurysm: A case report and literature review.

RATIONALE: Antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis (AAV) is characterized by necrotizing damage to small-vessel vasculitis and mainly occurs in the kidney or lung. We report a rare case of AAV manifesting as alveolar hemorrhage and a renal aneurysm. PATIENT CONCERNS: A 50-year-old Chinese man presented with repeated coughing, expectoration, fever, hypoxemia, and respiratory failure. The patient suffered from rupture of the renal aneurysm during immunosuppressive therapy. DIAGNOSIS: Considering the clinical picture (fever, progressive hypoxemia, renal insufficiency, hemorrhagic bronchoalveolar lavage fluid, and left retroperitoneal hematoma) along with cANCA-PR3 positivity, and lung biopsy findings, the patient was finally diagnosed with granulomatosis with polyangiitis complicated by alveolar hemorrhage and renal aneurysm. INTERVENTIONS: The patient was initially treated with immunosuppressive therapy combined with plasma exchange and subsequently with renal arterial embolization due to rupture of the renal aneurysm. OUTCOMES: The general condition and inflammatory reaction improved with immunosuppressive therapy combined with plasma exchange. Unfortunately, the patient did not respond to treatment and eventually died of respiratory failure and acute kidney injury after the rupture of the renal aneurysm. LESSONS: We encountered unprecedented difficulties and challenges with renal aneurysm rupture. The possibility of aneurysmal rupture should be carefully considered and frequently checked for immunosuppressive therapy for AAV.

Synthesis and fluorescence properties of two dendritic molecules based on naphthalimide and triphenylamine.

Artificial light-harvesting systems have attracted great interest in biological photosynthesis and photo-voltaic devices areas due to their unique structures, easy purification, low-cost, and convenient processing abilities. Here, two dendritic molecules based on triphenylamine and naphthalimide have been designed and synthesized, their structures were confirmed by 1 H NMR, ESI-MS, and high resolution mass spectrometry. In these molecules, triphenylamine units perform as the electron donor moiety, and naphthalimide units perform as the electron acceptor. The obvious quenched fluorescence intensity and considerably shortened lifetime of the dendritic molecules combined with the molecular frontier orbital energy levels proved that the dendritic molecules not only are good candidates as hole-transporting materials but also are two excellent photo-induced electron transfer materials. Therefore, it is believed that these dendritic molecules have potential application value in photo-voltaic devices.

Diagnosis of liver tumors by multimodal ultrasound imaging.

To investigate the diagnostic value of multimodal ultrasound imaging composed of conventional ultrasonography (US), contrast-enhanced ultrasonography (CEUS), and shear wave elastography (SWE) for liver tumors.Between October 2017 and October 2019, US, CEUS, and SWE examinations of a total of 158 liver tumors in 136 patients at The First Affiliated Hospital of Nanchang University were performed. The histopathological or imaging diagnostic results were used as controls to evaluate the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of US, CEUS, SWE, and multimodal ultrasound imaging, which combines these 3 modes, in the differential diagnosis of benign and malignant liver tumors.Among the 158 tumors, there were 64 benign tumors, including 55 cases of hepatic hemangioma, 3 cases of focal nodular hyperplasia of the liver, 4 cases of hepatic cyst, and 2 cases of focal nonuniform distribution of fat in the liver. There were 94 malignant tumors, including 32 cases of hepatocellular carcinoma, 22 cases of intrahepatic cholangiocellular carcinoma, 29 cases of metastatic liver cancer, and 11 cases of dysplastic nodules in cirrhotic liver. In the diagnosis of benign and malignant liver tumors, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 82.56%, 68.06%, 75.96%, 75.53%, and 76.56% for US; 92.39%, 86.36%, 89.87%, 90.43%, and 89.06% for CEUS; 87.14%, 76.81%, 82.91%, 82.98%, and 82.81% for SWE; and 97.85%, 95.38%, 96.83%, 96.81%, and 96.88% for multimodal ultrasound imaging, respectively. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were all significantly higher for multimodal ultrasound imaging than those values for US, CEUS, and SWE (all P < .05). The areas under the receiver operating characteristic curve for US, CEUS, SWE, and multimodal ultrasound imaging in the diagnosis of benign and malignant liver tumors were 0.760, 0.897, 0.829, and 0.968, respectively.US, CEUS, and SWE all have diagnostic value in the diagnosis of benign and malignant liver tumors. Multimodal ultrasound imaging could significantly increase the accuracy of the diagnosis of benign and malignant liver tumors and has higher value for clinical application.

[Changes of MMP-9 and TIMP-1 levels in gingival crevicular fluid during orthodontic tooth movement under orthodontic forces].

AIM: To investigate the dynamic changes of MMP-9 and TIMP-1 levels in gingival crevicular fluid during orthodontic tooth movement under orthodontic forces. METHODS: select 20 cases which fit experiment condition. The cases divided randomly into 2 groups, 1- cases for each group. The distal forces of 100g and 250 g were exerted to the canine on the one side of two groups separately. The GCF were taken before activation and at 1, 2, 3, 4, 5, 6, 7 week respectively after initiation of the experiment. The levels of MMP-9 and TIMP-1 in GCF were determined by ELISA. RESULTS: The levels of MMP-9 in A group began to increase at 1 week and reached to its peak value at 3 week after initiation of the experiment, but the level returned to baseline at 7 week. The levels of TIMP-1 in A group began to increase at 1, 2, 3 week and decreased at 4 week after initiation of the experiment, but the level at 6,7 week was higher than that before initiation of the experiment. The level of MMP-9 in A group was higher than that in B group at all times and the level of TIMP-1 in A group was lower than that in B group. CONCLUSION: The level of MMP-9 and TIMP-1 in GCF may play an importance role in maintaining the health, the regular remodeling of the periodontium and the fast-moving of orthodontic tooth.

Biomechanical effects of insertion location and bone cement augmentation on the anchoring strength of iliac screw.

BACKGROUND: Iliac screw loosening has been a clinical problem in the lumbo-pelvic reconstruction. Although iliac screws are commonly inserted into either upper or lower iliac column, the biomechanical effects of the two fixations and their revision techniques with bone cement remain undetermined. The purpose of this study was to compare the anchoring strengths of the upper and lower iliac screws with and without cement augmentation. METHODS: 5 pairs of formalin fixed cadaveric ilia with the bone mineral density values ranged from 0.82 to 0.97 g/cm(2) were adopted in this study. Using screws with 70-mm length and 7.5-mm diameter, 2 conventional iliac screw fixations and their revision techniques with cement augmentation were sequentially established and tested on the same ilium as follows: upper screw, upper cement screw, lower screw, and lower cement screw. Following 2000 cyclic compressive loading of -300 N to -100 N to the screw on a material testing machine, the maximum pull-out strengths were measured and analyzed. FINDINGS: The average pull-out strengths of upper, upper cement, lower, and lower cement screws were 964 N, 1462 N, 1537 N, and 1964 N, respectively. The lower screw showed significantly higher pull-out strength than the upper one (P=0.008). The cement augmentation notably increased the pull-out strengths of both upper and lower screws. The positive correlation between pull-out strength and bone mineral density value was obtained for the 4 fixations. INTERPRETATION: The lower iliac screw technique should be the preferred choice in lumbo-pelvic stabilization surgery; cement augmentation may serve as a useful salvage technique for iliac screw loosening; preoperative evaluation of bone quality is crucial for predicting fixation strength of iliac screw.

Biomechanical effects of the extent of sacrectomy on the stability of lumbo-iliac reconstruction using iliac screw techniques: What level of sacrectomy requires the bilateral dual iliac screw technique?

BACKGROUND: Although both single and dual iliac screw techniques are used in spino-pelvic reconstruction following sacrectomy for treating sacral tumors, the basis for choosing between the two techniques for different instability types remains undetermined. The purpose of this study was to evaluate the effects of the extent of sacrectomy on the stability of the lumbo-iliac fixation construct using single and dual iliac screw techniques. METHODS: Nine human L2-pelvic specimens were tested for their intact condition simulated by L3-L5 pedicle screw fixation. Sequential partial sacrectomies and L3-iliac fixation using bilateral single and dual iliac screws were conducted on the same specimens as follows: under-S1 sacrectomy+single screw, under-½S1 sacrectomy+single screw, one-side sacroiliac joint resection+single screw, total sacrectomy+single screw, and total sacrectomy+dual screw. Biomechanical testing was performed on a material testing machine for evaluating the stiffness of the L3-iliac fixation construct in compression and torsion. FINDINGS: Single iliac screw technique was found to effectively restore the local stability in under-½S1 sacrectomy. However, it could not provide adequate stability for further resection of one-side sacroiliac joint in torsion and total sacrectomy in compression (P<0.05). On the other hand, dual iliac screw technique could restore the stability to the intact condition after total sacrectomy in both compression and torsion. INTERPRETATION: The single iliac screw technique for L3-iliac fixation could effectively restore the local stability for under-½S1 sacrectomy. However, for instabilities of the under-½S1 sacrectomy with one-side sacroiliac joint resection or total sacrectomy, the dual iliac screw technique should be considered.

Physiologic effects of electroacupuncture combined with intramuscular administration of xylazine to provide analgesia in goats.

OBJECTIVE: To investigate physiologic effects of electroacupuncture (EA) combined with xylazine administration in goats. ANIMALS: 48 healthy crossbred goats. PROCEDURES: Goats were randomly allotted to 8 groups of 3 (nonpregnant and nonlactating) female goats and 3 male goats each. The 8 treatment groups were as follows: 1 EA group, 3 xylazine (0.1, 0.2, and 0.4 mg/kg, IM) groups, 3 EA plus xylazine (0.1, 0.2, and 0.4 mg/kg, IM) groups, and 1 control group. Electroacupuncture was performed for 90 minutes. Xylazine was administered 20 minutes after EA was performed. Pain threshold, heart rate, mean arterial pressure (MAP), respiration rate, and rectal temperature were observed at 0, 5, 25, 45, 65, and 85 minutes after xylazine administration. RESULTS: Xylazine administered at 0.4 mg/kg increased the pain threshold and reduced MAP. Xylazine administered at 0.1, 0.2, or 0.4 mg/kg reduced heart rate, respiration rate, and temperature. Electroacupuncture increased the pain threshold but had no effect on heart rate, MAP, respiratory rate, or rectal temperature. Pain threshold in goats that underwent EA plus xylazine administration was higher than in goats that received EA or xylazine alone. Electroacupuncture combined with xylazine at 0.1 mg/kg did not affect heart rate, MAP, respiratory rate, or rectal temperature. Pain threshold in goats that underwent EA plus xylazine administration at 0.1 mg/kg was higher than in goats given xylazine at 0.4 mg/kg alone. CONCLUSIONS AND CLINICAL RELEVANCE: Electroacupuncture combined with xylazine, even at 0.1 mg/kg, provided analgesia without significantly affecting cardiorespiratory parameters or rectal temperature in goats.

[Epstein-Barr virus infection in benign lymphoepithelial lesions with malignant transformation of salivary glands].

OBJECTIVE: To examine the role of Epstein-Barr virus (EBV) infection in benign lymphoepithelial lesions with malignant transformation of salivary glands. METHODS: 2 cases benign lymphoepithelial lesions with focal malignant transformation (BLEL-FMT), 14 cases of malignant lymphoepithelial lesion (MLEL) and 4 cases of benign lymphoepithelial lesion (BLEL) of salivary glands, 4 cases of nonspecific chronic sialadenitis were examined. Sections were cut from the paraffin blocks and performed in situ hybridization (ISH) for EBV encoded small RNA-1 (EBER-1) using 30-base synthesized oligonucleotide probe and polymerase chain reaction (PCR) for BamHI-W regein of EBV DNA (123 bp). RESULTS: In ISH, strong signals for EBER-1 were obtained in most of epithelial cell nuclei in examined specimens of BLEL-FMT, no matter in benign or malignant areas and in all specimens of MLEL (14/14), PCR demonstrated a DNA fragment of 123 kbp in 2 cases of BLEL-FMT and 12 cases of MLEL (12/14). In contrast, there were no significant ISH/PCR signals in examined BLEL and nonspecific chronic sialadenitis. CONCLUSIONS: A few cases of MLEL may arise from BLEL and EBV may plays an important role in the pathogenesis of BLEL-FMT of salivary glands.

[Epstein-Barr virus infection in lymphoepithelial carcinoma of salivary glands in Sichuan Chinese].

OBJECTIVE: To determine the prevalence of Epstein-Barr virus (EBV) infection in lymphoepithelial carcinoma (LEC) of salivary glands in Sichuan Chinese and discuss the role of EBV infection in pathogenesis of LEC. METHODS: Paraffin sections of 16 cases of LEC and 4 cases of benign lymphoepithelial lesion (BLEL) of salivary glands, 4 cases of non-specific chronic sialadenitis were examined by in situ hybridization for EBV encoded small RNA-1 (EBER-1) using 30-base synthesized oligonucleotide probe. RESULTS: Strong signals for EBER-1 were obtained in most of tumor cell nuclei in all the specimens of LEC (16/16); in contrast, there were no significant signals observed in the examination of 4 cases of BLEL and 4 cases of non-specific chronic sialadenitis. CONCLUSION: The results indicate that EBV plays an important role in the pathogenesis of LEC of salivary glands in Sichuan Chinese.