Case report: Staged tension-reducing excision of giant acquired vulvar lymphangioma secondary to cervical cancer surgery.

Introduction: Acquired vulvar lymphangioma (AVL), a rare disease caused by the dilation of superficial lymphatic vessels secondary to deep lymphatic vessel injury, is characterized by a wide range of morphological diversity and massive exudate. This morphological heterogeneity has often led to misdiagnosis or non-diagnosis. The management of AVL presents a therapeutic challenge due to the absence of a standardized treatment protocol. Case presentation: A 53-year-old female patient, previously received surgical treatments for stage IIb cervical squamous cell carcinoma, presented with vulvar enlargement and copious amount of yellow exudate seven years post-treatment. Clinically, the patient exhibited chronic vulvar swelling, with easily-exudated nodules. The vulvar biopsy revealed lymphatic vessel dilation with lymphocyte infiltration, consistent with AVL. Due to the extensive lesions and severe exudate, staged excisions of bilateral vulvar lesions were performed at one-month intervals. Follow-up examinations of this patient for one-year post-surgery showed no evidence of recurrence. Conclusion: In this instance, AVL manifest secondary to cervical cancer surgery, as a result of damage to the deep lymphatic vessels of the vulva, with characteristic symptoms of copious amounts of exudate and vulvar lesions with diverse morphologies, which provides a cautionary note for physicians. Besides, the staged resection strategy in this case may offer insights into surgical treatment protocol for extensive AVL.

Effect of erythromycin on the ultrastructure of human macrophages exposed to cigarette smoke extract in vitro.

Macrophages serve an active role in the pathophysiology of chronic obstructive pulmonary disease (COPD). Erythromycin (EM) has been verified as an effective treatment for COPD. However, there are few studies on the effect of EM on the ultrastructure of macrophages exposed to cigarette smoke extract (CSE). In the present study, human macrophages were randomly divided into three groups: The control, CSE and the CSE+EM group, using electron microscopy, the effect of EM was evaluated by comparing the ultrastructural changes between these groups. The macrophages were additionally divided into a further four groups: The control, CSE, CSE+EM 24 h and CSE+EM 48 h groups. The generation of reactive oxygen species (ROS) in each group was evaluated by detecting fluorescence intensity. It was observed that the cellular ultrastructure of the CSE group exhibited abnormal changes, though this effect was reversed back to the level of the control in the CSE+EM group. Compared with the control group, the ROS expression level was significantly increased in the CSE group (P < .05); however, compared with the CSE group, the ROS concentration was decreased in the CSE+EM 24 h (P < .05) and CSE+EM 48 h groups (P < .05), though this was more apparent in the EM 48 h group. It was concluded that EM protects human macrophages against CSE. Moreover, it was hypothesized that EM may reduce the symptoms of patients with COPD by protecting the macrophage ultrastructure from the effects of CSE, resulting in the decreased generation of ROS, inhibiting autophagy and reducing endoplasmic reticulum stress.

Effect and satisfaction of outpatient services by precision valuation reservation registration.

BACKGROUND: Due to improvements in living standards, people are now paying more attention to their health. In China, more patients choose to go to large or well-known hospitals, which leads to constant crowding of outpatient clinics in these hospitals. AIM: To establish precision valuation reservation registration aimed at shortening waiting time, improving patient experience and promoting the satisfaction of outpatients and medical staff. METHODS: On the basis of the implementation of a conventional appointment system, more reasonable time intervals were set for different doctors by evaluating the actual capacity of each doctor to receive patients, and appointment times were made more accurate through intervention. The change in consultation waiting time of patients was then compared. Correlations between the consultation waiting time of patients and the satisfaction of patients or satisfaction of medical staff were analyzed. RESULTS: After precision valuation reservation registration, the average consultation waiting time of patients reduced from 18.47 min to 10.11 min (t = 8.90, P < 0.001). The satisfaction score of patients increased from 91.33 to 96.27 (t = -8.62, P < 0.001), and the satisfaction score of medical staff increased from 90.51 to 96.04 (t = -10.50, P < 0.001). The consultation waiting time of patients was negatively correlated with their satisfaction scores (γ = -0.89, P < 0.001). The consultation waiting time of patients was also negatively correlated with medical staff satisfaction scores (γ = -0.96, P < 0.001). CONCLUSION: Precision valuation reservation registration significantly shortened outpatient waiting times and improve the satisfaction of not only patients but also medical staff. This approach played an important role in improving outpatient services, provided a model that is supported by relevant evidence and could continuously improve the quality of management. Precision valuation reservation registration is worth promoting and applying in the clinic.

Efficacy and prognosis of surgical treatment in ARMM and its effects on immune and inflammatory profiles.

The aim of the present study was to investigate the efficacy and prognosis of surgical treatment in anorectal malignant melanoma (ARMM) as well as its effects on immune and inflammatory profiles. A total of 64 patients with ARMM were enrolled and divided into control group (n=32) and observation group (n=32) based on different therapeutic methods. Patients in the observation group underwent wide local excision, while those in the control group were given non-surgical treatment. The immune function was compared between the two groups after treatment. The expression levels of serum IL-17, IL-23 and vascular endothelial growth factor (VEGF) were compared between the groups before and after treatment. Patients were followed up for 5 years to observe the recurrence and survival rates in the two groups. Compared with those in the control group, the levels of cluster of differentiation (CD)3+, CD4+ and CD4+/CD8+ were increased, while the level of CD8+ was reduced in the observation group (P<0.05). The levels of serum IL-17, IL-23 and VEGF were significantly lower in both groups at 4, 6 and 8 weeks after treatment than those before treatment, and the decrease was more obvious in the observation group (P<0.05). The observation group exhibited a notably elevated 5-year survival rate and a remarkably decreased recurrence rate in comparison with the control group (P<0.05). For ARMM, surgical treatment is more effective than non-surgical treatment, which has less effect on immune function, is able to reduce serum IL-17, IL-23 and VEGF levels, lower recurrence rate, improve patient survival rate, and plays a certain positive role in prolonging the survival time of ARMM patients.

[Mechanisms of electroacupuncture underlying treatment of osteoporosis based on HDAC2-mediated osteoblast differentiation pathway].

OBJECTIVE: To observe the effect of electroacupuncture (EA) on expression of histone deacetylase 2 (HDAC2), histone H3, bone formation related genes and proteins in osteoporosis rats, so as to reveal its mechanisms underlying improvement of osteoporosis. METHODS: Female SD rats were randomly divided into 4 groups: sham operation, model, EA and medication (n＝ 10 rats in each group). The osteoporosis model was established by castration. EA (2 Hz, 1 mA) was applied to bilateral "Shenshu" (BL23) and "Pishu" (BL20) for 10 min, once every other day for 8 weeks. Rats of the medication group received subcutaneous injection of 17 ß-estradiol (100 µg/kg, 20 µg/mL). The bone quality and quantity including the cortical bone mineral density (CBMD), trabecular bone mineral density (TBMD), ratio of bone volume /total volume (BV /TV), trabecular thickness (Tb.Th), trabecular number (Tb.N), trabecular separation (Tb. Sp), trabecular bone pattern factor (Tb.Pf), and structure model index (SMI) of the right thigh-bone were detected by using a micro-computed tomography. Serum alkaline phosphatase (ALP) and estrogen 2 (E2) contents were assayed by using colorimetry and ELISA, expression levels of HDAC2, histone H3 and Runx2 in the thigh-bone were detected using Western blot, and that of Runx2 mRNA was detected using quantitative real-time PCR, separately. The co-expression of Ac-histone H3/Runx2 and Runx2/ALP was observed by using immunofluorescence histochemical staining. RESULTS: After modeling, the levels of TBMD, BV/TV, Tb.Th, and Tb.N, serum E2 and ALP, and expression of Runx2 protein and mRNA, Ac-histone and ALP proteins were significantly lower (P<0.01), and those of Tb.Sp, Tb.Pf and SMI, HDAC2 and histone H3 proteins were significantly higher (P<0.01) in the model group than those in the sham operation group. After the interventions, the decrease of TBMD, BV/TV, Tb.N，Runx2 protein and mRNA，ALP in both EA and medication groups, serum E2 in the medication group, and Ac-histone H3 in the EA group, and the increase of Tb.Sp in the medication group, Tb.Pf, SMI, and HDAC2 in both EA and medication groups, and histone H3 in the EA group were reversed (P<0.01, P<0.05). No significant changes were found in the levels of CBMD after modeling relevant to the sham operation group, and after EA and medication interventions (P>0.05). The effects of EA were significantly superior to 17 ß-estradiol in down-regulating the expression of HDAC2 and histone H3 proteins and in up-regulating expression of Ac-histone H3 protein (P<0.01，P<0.05)．. CONCLUSION: EA treatment can increase bone density, increase bone mass and trabecular bone, and promote trabecular bone rod-like changes in plate shape in osteoporosis rats, which is related to its effect in up-regulating the expression of Ac-histone H3 protein, and down-regulating the expression of bone formation-related proteins.

New Chinese dietary guidelines: healthy eating patterns and food-based dietary recommendations.

BACKGROUND AND OBJECTIVES: The Chinese Dietary Guidelines (CDGs) were first released to the public in 1989 by the Chinese Nutrition Society (CNS). In 2016, the Ministry of Health commissioned the CNS to revise and publish new CDGs. METHODS AND STUDY DESIGN: The CNS convened an expert committee of leaders in the fields of nutrition, epidemiology, public health, preventive medicine, and food science. The CDGs were revised according to the World Health Organization Handbook for Guideline Development procedures. The expert committee recommended key inclusions for the CDGs on the basis of the current status of public health and priority health challenges affecting the Chinese population, as well as the quality of scientific evidence. RESULTS: The CDGs (2016) provide six key dietary recommendations for the general Chinese population aged 2 years and above. In addition to a newly revised Chinese Food Guide Pagoda, both the Chinese Food Guide Plate and Chinese Food Guide Abacus are newly created pictorial models in the CDGs (2016); the Chinese Food Guide Abacus is specifically designed for children. Seven additional dietary guidelines targeting specific populations are included; these guidelines emphasize the different physiological and nutritional requirements of particular populations, including dietary guidelines for vegetarians for the first time. CONCLUSIONS: The CDGs (2016) is an official document published by the National Health Commission of China. Its content highlights the current status of public health and offers advice to address health concerns faced by the Chinese population. The CDGs (2016) have been widely disseminated and accepted in the Chinese population; the National Nutrition Week is a major national event in which the CDG are used as its core to increase public awareness towards a healthy diet and lifestyle.

Flexible P-Doped Carbon Cloth: Vacuum-Sealed Preparation and Enhanced Na-Storage Properties as Binder-Free Anode for Sodium Ion Batteries.

In this work, a flexible and self-supporting P-doped carbon cloth (FPCC), which is composed of interwoven mesh of hollow microtubules with porous carbon walls, is prepared via a vacuum-sealed doping technology by employing the commercially available cotton cloth as sustainable and scalable raw material. When directly used as binder-free anode for sodium-ion batteries, the as-prepared FPCC delivers superior Na-storage properties in terms of specific capacity up to 242.4 mA h g-1, high initial Coulombic efficiency of ∼72%, excellent rate capabilities (e.g., 123.1 mA h g-1 at a high current of 1 A g-1), and long-term cycle life (e.g., ∼88% capacity retention after even 600 cycles). All these electrochemical data are better than the undoped carbon cloth control, demonstrating the significance of P-doping to enhance the Na-storage properties of cotton-derived carbon anode. Furthermore, the technologies of electrochemical impedance spectroscopy and galvanostatic intermittent titration technique are implemented to disclose the decrease of charge transfer resistance and improvement of Na-migration kinetics, respectively.

Formononetin exhibits anti-hyperglycemic activity in alloxan-induced type 1 diabetic mice.

The aim of this study was to investigate the anti-hyperglycemic activity and mechanism of formononetin in alloxan-induced type 1 diabetic mice by determining its effect on some diabetes-related indices as described below. Body weight, fasting blood glucose, hepatic glycogen, serum insulin, and serum glucagon were determined by electronic scales, glucometer, and ELISA kits. Fas, Caspase-3, pancreatic and duodenal homeobox-1 , insulin receptor substrate 2, glucokinase and glucose transporter 2, mRNA and proteins levels in pancreas tissue, and glucokinase and glucose-6-phosphatase mRNA, and proteins levels in liver tissue were detected by fluorogenic quantitative-polymerase chain reaction and Western blot assays. The results indicated that formononetin (5, 10, and 20 mg/kg; oral administration) reversed the alloxan-induced increase of some indices (fasting blood glucose level and Fas and Caspase-3 mRNA and proteins levels in pancreas tissue) and reduction of some indices (body weight gain, oral glucose tolerance, insulin activity, hepatic glycogen level, pancreatic and duodenal homeobox-1, insulin receptor substrate 2, glucokinase and glucose transporter 2, mRNA and proteins levels in pancreas tissue, and glucokinase mRNA and protein levels in liver tissue). The glucagon level and glucose-6-phosphatase mRNA and protein levels in liver tissue were not affected by the drugs administration. In conclusion, formononetin exhibited anti-hyperglycemic activity in alloxan-induced type 1 diabetic mice by inhibiting islet B cell apoptosis and promoting islet B cell regeneration, insulin secretion, hepatic glycogen synthesis, and hepatic glycolysis.

An accelerated failure time model for investigating pedestrian crossing behavior and waiting times at signalized intersections.

The waiting process is crucial to pedestrians in the street-crossing behavior. Once pedestrians terminate their waiting behavior during the red light period, they would cross against the red light and put themselves in danger. A joint hazard-based duration model is developed to investigate the effect of various covariates on pedestrian crossing behavior and to estimate pedestrian waiting times at signalized intersections. A total of 1181 pedestrians approaching the intersections during red light periods were observed in Beijing, China. Pedestrian crossing behaviors are classified into immediate crossing behavior and waiting behavior. The probability and effect of various covariates for pedestrians' immediate crossing behavior are identified by a logit model. Four accelerated failure time duration models based on the exponential, Weibull, lognormal and log-logistic distributions are proposed to examine the significant risk factors affecting duration times for pedestrians' waiting behavior. A joint duration model is developed to estimate pedestrian waiting times. Moreover, unobserved heterogeneity is considered in the proposed model. The results indicate that the Weibull AFT model with shared frailty is appropriate for modelling pedestrian waiting durations. Failure to account for heterogeneity would significantly underestimate the effects of covariates on waiting duration times. The proposed model provides a better understanding of pedestrian crossing behavior and more accurate estimation of pedestrian waiting times. It may be applicable in traffic system analysis in developing countries with high flow of mixed traffic.

A hazard-based duration model for analyzing crossing behavior of cyclists and electric bike riders at signalized intersections.

This paper presents a hazard-based duration approach to investigate riders' waiting times, violation hazards, associated risk factors, and their differences between cyclists and electric bike riders at signalized intersections. A total of 2322 two-wheeled riders approaching the intersections during red light periods were observed in Beijing, China. The data were classified into censored and uncensored data to distinguish between safe crossing and red-light running behavior. The results indicated that the red-light crossing behavior of most riders was dependent on waiting time. They were inclined to terminate waiting behavior and run against the traffic light with the increase of waiting duration. Over half of the observed riders cannot endure 49s or longer. 25% of the riders can endure 97s or longer. Rider type, gender, waiting position, conformity tendency and crossing traffic volume were identified to have significant effects on riders' waiting times and violation hazards. Electric bike riders were found to be more sensitive to the external risk factors such as other riders' crossing behavior and crossing traffic volume than cyclists. Moreover, unobserved heterogeneity was examined in the proposed models. The finding of this paper can explain when and why cyclists and electric bike riders run against the red light at intersections. The results of this paper are useful for traffic design and management agencies to implement strategies to enhance the safety of riders.

Waiting endurance time estimation of electric two-wheelers at signalized intersections.

The paper proposed a model for estimating waiting endurance times of electric two-wheelers at signalized intersections using survival analysis method. Waiting duration times were collected by video cameras and they were assigned as censored and uncensored data to distinguish between normal crossing and red-light running behavior. A Cox proportional hazard model was introduced, and variables revealing personal characteristics and traffic conditions were defined as covariates to describe the effects of internal and external factors. Empirical results show that riders do not want to wait too long to cross intersections. As signal waiting time increases, electric two-wheelers get impatient and violate the traffic signal. There are 12.8% of electric two-wheelers with negligible wait time. 25.0% of electric two-wheelers are generally nonrisk takers who can obey the traffic rules after waiting for 100 seconds. Half of electric two-wheelers cannot endure 49.0 seconds or longer at red-light phase. Red phase time, motor vehicle volume, and conformity behavior have important effects on riders' waiting times. Waiting endurance times would decrease with the longer red-phase time, the lower traffic volume, or the bigger number of other riders who run against the red light. The proposed model may be applicable in the design, management and control of signalized intersections in other developing cities.

Synthesis, crystal structure, spectra and quantum chemical study on 1-phenyl-3-(4-nitrophenyl)-5-(2-thienyl)-2-pyrazoline.

1-Phenyl-3-(4-nitrophenyl)-5-(2-thienyl)-2-pyrazoline was synthesized and characterized by elemental analysis, IR and X-ray single crystal diffraction. UV-Vis spectra and fluorescence spectra were measured. Density functional theory calculations on the structure of the title compound were performed at the B3LYP/6-311G** level of theory. NPA atomic charge distributions indicate that, although the S atom in the thienyl ring loses coordination capacity, the title compound still may be used as a potential multi-dentate ligand to coordinate with metallic ions. The calculation of the second order optical nonlinearity was carried out. Natural bond orbital analyses indicate that the electronic absorption bands are mainly derived from the contribution of n→π* and π→π* transitions. Fluorescence spectra determination shows that the title compound is a potential orange-light emitting material.

Does diffusion tensor tractography of the corticospinal tract correctly reflect motor function?

OBJECTIVE: To investigate the consistency of diffusion tensor tractography of the corticospinal tract on motor function. CLINICAL PRESENTATIONS AND INTERVENTION: Three patients with brain tumor were admitted to our hospital with impaired motor function. Diffusion tensor imaging (DTI) and tractography were performed in these patients to assess their affected corticospinal tract. The corticospinal tract showed interruption with moderately impaired motor function in 2 patients. The third case had significantly weakened muscle strength on the left upper limb but an intact right corticospinal tract. CONCLUSION: These cases showed that the corticospinal tracts obtained by DTI with tractography were inconsistent with motor function. Hence, DTI should be interpreted with caution.

Differentiation of pure vasogenic edema and tumor-infiltrated edema in patients with peritumoral edema by analyzing the relationship of axial and radial diffusivities on 3.0T MRI.

OBJECT: The purpose of this study was to analyze the relationship of axial diffusivity (AD) and radial diffusivity (RD) in peritumoral edema of high grade glioma, metastasis, and meningioma, and to differentiate tumor-infiltrated edema from pure vasogenic edema. MATERIALS AND METHODS: Twenty patients with high-grade glioma and 16 with meningioma or metastatic tumor were enrolled in our study. All cases were confirmed by histopathological study. Diffusion tensor imaging (DTI) was performed in all patients. Peritumoral edema of high-grade glioma was considered tumor-infiltrated edema, and edema of meningioma or metastasis was considered pure vasogenic edema. Fractional anisotropy (FA), mean diffusivity (MD), AD, RD, regression coefficient of RD to AD (RCRD-AD), and tumor infiltration index (TII) in tumor-infiltrated edema and pure vasogenic edema were analyzed and compared. Receiver operating characteristic (ROC) curve analysis was conducted to demonstrate their differential effectiveness. RESULTS: RCRD-AD in tumor-infiltrated edema (0.724±0.125) was significantly higher than that in pure vasogenic edema (0.571±0.111) (P=0.001). FA of tumor-infiltrated edema (0.175±0.025) was significantly lower than that of pure vasogenic edema (0.203±0.035) (P=0.007). Other parameters showed no significant difference between the 2 types of edema. ROC curve analysis showed RCRD-AD was the most effective parameter in distinguishing tumor-infiltrated edema from pure vasogenic edema. Using a threshold of 0.6, a sensitivity of 0.85 and specificity of 0.69 can be achieved with RCRD-AD. CONCLUSION: Analysis of the AD and RD relationship may reflect differences in diffusion characteristics of edema surrounding high-grade glioma and meningioma or metastasis, and may be helpful in detecting peritumoral infiltration in high-grade glioma.

[HIV-1 infection up-regulating expression of interferon-stimulated gene 15 in cell lines].

To investigate whether HIV-1 infection affects expression of interferon-stimulated gene 15 (ISG15) and determine the antiviral effect of ISG15 in vitro, ISG15 expression at transcription and protein level and supernatant p24 of HIV-1 was detected in various HIV-1 infected or transfected cell lines, respec tively. HIV-1 molecular clone pNL4-3 was used to transfect 293T, TZM-bl and HeLa cells while HIV-1 pseudo-typed virus was used to infect Jurkat, MT-1 and THP-1 cells. After twenty-four hours post infection or transfection, cells were harvested for extraction of total RNAs and subsequently used in real time PCR for quantification of ISG15 transcriptional expression. After forty-eight hours post infection or transfection, cells were harvested for extraction of total proteins to detect ISG15 protein expression. A significant up-regulation of ISG15 at transcription level was observed in HIV-1 infected or transfected cell lines, particulaly in THP-1 and TZM-bl cells. Up-regulation of ISG15 protein was observed only in TZM-bl cell. Cotransfection of ISG15 and HIV-1 indicated that ISG15 inhibited production of HIV-1 progeny virus in a dose and time depend manner in 293T cell but not TZM-bl cell. These results revealed upregulating ISG15 expression in transcriptional level and potential antagonistic mechanism against ISG15 by HIV-1 infection, simultanelusly.

5-tert-Butyl 3-ethyl 1-isopropyl-4,5,6,7-tetra-hydro-1H-pyrazolo-[4,3-c]pyridine-3,5-dicarboxyl-ate.

In the title compound, C(17)H(27)N(3)O(4), the six-membered ring adopts a half-chair conformation with the N atom and the adjacent methyl-ene C atom displaced by -0.391 (2) and 0.358 (2) Å, respectively, from the plane of the other four atoms. In the crystal, mol-ecules are linked by weak C-H⋯O inter-actions.

(3S,12R,20S,24R)-20,24-Ep-oxy-dammarane-3,12,25-triol.

In the title mol-ecule, C(30)H(52)O(4), the three six-membered rings are in chair conformations, the cyclo-pentane ring is in an envelope form and the tetra-hydro-furan ring has a conformation inter-mediate between half-chair and sofa. In the crystal, mol-ecules are linked by inter-molecular O-H⋯O hydrogen bonds into helical chains along [100]. Two intra-molecular O-H⋯O hydrogen bonds are also present. One C atom of the tetrahydrofuran ring and its attached H atoms are equally disordered over two sets of sites.

6-Benzyl 4-ethyl 2-chloro-5,6,7,8-tetra-hydro-pyrido[4,3-d]pyrimidine-4,6-di-carboxyl-ate.

In the title compound, C(18)H(18)ClN(3)O(4), the dihedral angle between the pyrimidine ring and the N-bonded ester grouping is 56.27 (7)° and the dihedral angle between the aromatic rings is 11.23 (7)°.

N-Cyclo-propyl-N-[2-(2,4-difluoro-phen-yl)-2-hy-droxy-1-(1H-1,2,4-triazol-1-yl)prop-yl]-2-(5-methyl-2,4-dioxo-1,2,3,4-tetra-hydro-pyrimidin-1-yl)acetamide dichloro-methane 0.62-solvate.

In the title compound, C(21)H(22)F(2)N(6)O(4)·0.62CH(2)Cl(2), the difluoro-substituted benzene ring forms dihedral angles of 54.6 (3)° with the mean plane of the thymine ring and 50.9 (2)° with the triazole ring. The dihedral angle between the thymine and triazole rings is 7.4 (3)°. In the crystal, inter-molecular N-H⋯N and O-H⋯O hydrogen bonds link the main mol-ecules into chains along [10[Formula: see text]]. The CH(2)Cl(2) solvent mol-ecule was refined as partial occupancy over two sets of sites with refined occupancies of 0.308 (9) and 0.310 (8).

7-Benzyl-2,7-diaza-spiro-[4.4]nonan-1-one.

In the title compound, C(14)H(18)N(2)O, both the spiro-linked five-membered rings adopt envelope conformations, with a C atom as the flap in one ring and an N atom in the other. The dihedral angle between the two four-atom planes is 80.46 (8)°. In the crystal, the mol-ecules are linked by N-H⋯O hydrogen bonds to generate C(4) chains propagating in [010].