[A case of metastatic breast cancer complicated by pulmonary tumor thrombotic microangiopathy].

Pulmonary tumor thrombotic microangiopathy is a malignancy-related complication with rapid progression and high mortality. To improve the understanding of the disease, early diagnosis and treatment are key to successful treatment. A 39-year-old patient with pulmonary hypertension transferred from another hospital was admitted to the First Affiliated Hospital of Guangzhou Medical University on September 26, 2021. The patient developed shortness of breath and progressive exacerbation over the past month. No pulmonary artery embolism was seen on computed tomography pulmonary angiography (CTPA) at the outside hospital where the breast cancer was diagnosed. Pulmonary tumor thrombotic microangiopathy was immediately considered on admission and oncological endocrine therapy was started. After treatment, the patient's dyspnoea improved, PET-CT showed significant tumor regression, and cardiac ultrasound showed a significant decrease in pulmonary artery pressure. The successful treatment experience of this case was summarized for reference.

Development and implementation of a pneumatic micro-feeder for poorly-flowing solid pharmaceutical materials.

Consistent powder micro-feeding (<100 g/h) is a significant challenge in manufacturing solid oral dosage forms. The low dose feeding can well control the content consistency of the dosage forms, which improves drug efficiency and reduces manufacturing waste. Current commercial micro-feeders are limited in their ability to feed < 20 g/h of cohesive (i.e. powders of poor flowability) active pharmaceutical ingredients (API) and excipients (e.g. lubricants) with low fluctuation. To breach this gap, this study presents an advanced micro-feeder design capable of feeding a range of pharmaceutical-grade powders consistently at flow rates as low as 0.7 g/h with <20 % flow rate variation. This was possible due to a novel powder conveying concept utilising particle re-entrainment to minimise flow rate variations. This work details the design of this pneumatic micro-feeder and its excellent micro-feeding performance even for cohesive powders. The experimental studies investigated the influence of the process parameters (air pressure and air flow rate) and equipment configurations (insert size and plug position) on the feeding performance of different pharmaceutical-relevant powders, i.e., microcrystalline cellulose (MCC), croscarmellose sodium (CCS), crospovidone (XPVP) and paracetamol (APAP). It was shown that the system is capable of delivering consistent powder flow rates with good repeatability and stability.

[Endovascular repair of ruptured abdominal aortic aneurysms assisted by double balloon occlusion technique combined with intra-aneurysm fibrin binder injection technique].

Objective: To investigate the long-term efficacy and safety of alternating double balloon occlusion combined with intra-aneurysm injection of human fibrin binder in the endovascular repair of ruptured abdominal aortic aneurysm (rAAA). Methods: The clinical data of 28 patients with rAAA admitted to Department of Vascular Surgery, the Fourth Affiliated Hospital of Guangxi Medical University from January 2015 to December 2019 were retrospectively analyzed. There were 23 males and 5 females, aged (62±5) years (range: 46 to 88 years).The maximum diameter of the tumors was (65.2±10.5) mm (range: 47.3 to 100.5 mm), all of which were subrenal rAAA. The intraoperative EVAR for abdominal aortic aneurysm was successfully performed under the emergency green channel procedure, and this surgery was assisted used the double balloon occlusion technique in aorta of inferior renal and superior renalcombined with intraoperative human fibrin binder injection technique. Observation indexes included: patients with preoperative preparation, operation time, hospitalization days, surgical treatment success rate and the incidence of postoperative complications, and aortic stent form during the follow-up period, the incidence of leakage, branch stents patency rate and infection rates. Results: The preoperative preparation time of 28 patients was (45.5±8.5) minutes (range:20 to 100 minutes). The operation time was (100.0±15.5) minutes (range:85 to 210 minutes), the ICU stay time was (7±2) days(range:1 to 17 days). The length of hospitalization was (13.5±2.5) days(range:5 to 43 days). The success rate of surgical treatment was 92.9% (26/28). Two patients died, 1 case died of postoperative multifocal lacunar cerebral infarction and massive gastrointestinal hemorrhage, and another elderly patient (84 years old) died of massive abdominal fluid due to preoperative abdominal aortic aneurysm rupture, postoperative complicated with significant abdominal compartment syndrome, and secondary multiple organ failure. Balloon occlusion of the upper renal aorta took (13±2)minutes (range:12 to 30 minutes). The intraoperative injection of fibrin adhesive was (14±2) ml(range:6 to 28 ml) in 22 cases. The incidence of major postoperative complications was 57.1% (16/28). Among the 26 patients who survived the surgery, 69.2% (18/26) completed the 3-year follow-up, and the follow-up time was (30±3) months(range:13 to 36 months). During the follow-up, the aortic stent was in good shape without obvious displacement. The incidence of leakage within 6 months after the operation was 10.7% (3/28), and there was no internal leakage in the patients who were followed up for 36 months after the operation. The patency rate of renal artery and iliac artery branch stents was 16/18. The incidence of stent infection was 7.7% (2/26), 1 case occurred at 1 month and another case at 6 months, respectively. All patients recovered after prolonged intensive anti-infection therapy. Conclusions: Under the standard emergency treatment process, the double balloon alternating occlusion technique combined with the intra-aneurysm injection of human fibrin adhesive technique can assist the successful completion of the endovascular repair of rAAA, effectively improve the success rate of treatment for patients, and reduce the incidence of postoperative leakage and serious complications. The mid-term and long-term results of EVAR for rAAA are good, safe and reliable.

[Genomic investigation of human Streptococcus suis infection in Shandong Province].

To investigate Streptococcus suis (S.suis) isolated from patients in Shandong province using genomic epidemiology and pathogenologic analysis. To provide the foundation to establish reasonable and accurate prevention and control measures of human S. suis infection. Molecular typing, whole genome phylogenetic tree, virulence gene typing, antibiotic resistance profile and mobile genetic elements carrying antibiotic resistance genes of isolated S. suis strains were investigated. The pathogenicity of isolated strains was also evaluated by comparing their capacity to induce pro-inflammatory cytokine production in vitro. S. suis infections in Shandong province were predominantly due to serotype 2 and sequence type 1 strains. The major symptoms were meningitis. The studied strains could be divided into five lineages. All strains belong to highly pathogenic type in Shandong province,Strains from lineage 2 possessed higher capacity to stimulate pro-inflammatory cytokine production than other strains did, even though other strains belong to highly pathogenic strains. In addition, multiple antibiotic resistance genes and corresponding mobile genetic elements werewidespread in S. suis strains from Shandong province, except strains from lineage 3. High diversities in genome, evolutionary path and pathogenicity of S. suis strains from Shandong province were revealed. It was necessary to surveillant the S. suis strain in genomic level.

The relationship between regulatory T cells and radiation therapy.

Radiation therapy (RT) is an effective treatment for cancer. Approximately, 70% of cancer patients receive RT in China. The immune-modulating effect of radiation therapy have gained considerable interest in recent years and there have been multiple reports of synergy between radiation and immunotherapy. Regulatory T cells (Tregs) are a group of T cell subsets with immunosuppressive function, which is correlated with cancer. Tregs are involved in the pathogenesis, development, treatment and prognosis of tumors by cell-cell contact, cytokines, and cell metabolism. Based on the immunological characteristics of Tregs, this article reviews the interaction between RT and immune molecules, aiming to provide new ideas for RT combined with immunotherapy.

PERPETRATION OF VIOLENCE BY FEMALE SEX WORKERS IN PAPUA NEW GUINEA: 'WE WILL CRUSH THEIR BONES'.

There is a small but important body of literature on female sex workers' (FSWs) violence towards others, but little of that focused on low- and middle-income countries. Drawn from a larger biobehavioural study of FSWs in three cities in Papua New Guinea, we analyse the interviews from 19 FSWs who reported having perpetrated physical violence towards four major groups: (1) ex-husbands; (2) clients; (3) other sex workers and (4) other people (mainly women). Our study demonstrates that FSWs' use of violence arises from a complex set of social, material and gendered circumstances and cannot be addressed in isolation from other aspects of their lives.

[Application of adaptive statistical iterative reconstruction V (ASIR-V) in contrast-enhanced abdominal scanning with low-dose for liver cirrhosis].

Objective: To investigate the application of adaptive statistical iterative reconstruction-V (ASIR-V) in contrast-enhanced abdominal CT scanning with low-dose for liver cirrhosis. Methods: From June 2017 to May 2018, a total of 112 liver cirrhosis patients who underwent contrast-enhanced abdominal CT scanning were collected prospectively as the study group. According to Child-Pugh grading of liver function, the study group was divided into A, B and C groups. Thirty examiners with normal liver function who underwent contrast-enhanced abdominal CT scanning no abdominal diseases were collected as the control group. The control group applied 0 pre-ASIR-V. The study group applied 30%, 40% and 50% pre-ASIR-V in plain scanning, arterial and portal vein phase, respectively. The control and study group both combined with 60% post-ASIR-V. The difference of qualitative parameters (contrast to noise ratio of the liver, pancreas, spleen, abdominal aorta and portal vein), image noise and radiation dose were compared by One-way ANOVA. Subjective score of images were compared by Kruskal-Wallis H test. Results: The volume computed tomography dose index (CTDI(vol)), dose length product (DLP) and the effective dose (ED) of study group were lower than the control group in the same phase (F=13.354-28.192, P<0.01). And the ED were decreased by 1.12 (23.9%), 1.54 (33.5%), 2.14 mSv (46.7%). The CNR values of liver and portal vein in Child C group was 0.34-0.42 and 0.43-0.49 lower than that of Child A and control group, respectively (q=2.851-4.658, P<0.05). Image noise had no difference in study and control group. There were no statistical differences between each group of subjective score in arterial and portal vein phase. The mean score of Child C in portal phase was lower than 3, which affected the diagnosis. And there were significant difference among the control, Child A and Child C group(Z=26.734-29.218, P<0.05). Conclusions: According to the classification of liver function, liver cirrhosis combined with ASIR-V can ensure the image quality while reduce the radiation dose. When liver function is Child-Pugh A or B, preset 50%ASIR-V is recommended; 40%ASIR-V is recommended for Child-Pugh C.

HMGA1 promoting gastric cancer oncogenic and glycolytic phenotypes by regulating c-myc expression.

The high mobility group A1 (HMGA1) protein, an architectural transcription factor, is profoundly implicated in the pathogenesis and progression of multiple malignant tumors. Reprogrammed energy metabolism is a hallmark of diverse types of cancer cells. However, little is known about the regulatory role of HMGA1 in aerobic glycolysis. In this study, we found that HMGA1 was highly expressed in many types of human cancers including gastric cancer and predicted a poor prognosis. However, high HMGA1 expression was not correlated with TNM stages. Gene set enrichment analysis result suggested a link between HMGA1 expression and glycolytic phenotype in gastric cancer. Genetic silencing of HMGA1 significantly inhibited gastric cancer glycolytic activity as revealed by reduced glucose uptake, lactate release, and extracellular acidification ratio. In addition, cell proliferation and invasive capacity of gastric cancer cells were also suppressed by HMGA1 knockdown. Mechanistically, the key glycolysis regulator c-Myc was identified as a downstream target of HMGA1. In gastric cancer patients, HMGA1 and c-Myc expression were closely associated with the glycolysis gene signature. Taken together, our findings identify a novel function of HMGA1 in regulating aerobic glycolysis in gastric cancer.

[Trans-ethnic analysis of susceptibility variants in IgA nephropathy].

OBJECTIVE: To compare the genetic architecture of susceptibility variants of IgA nephropathy (IgAN) in Chinese and Europeans. METHODS: We selected the independent genome-wide significant variants of IgAN in European population as candidate variants. Their associations, risk alleles, risk allele frequencies, odds ratios and population attributable risk scores were derived and calculated, then compared with those in the current Chinese population, including 1 194 IgAN patients and 902 controls. Using the significant variants, genetic risk scores were calculated and compared between the East Asians and the Europeans. The correlation between the genetic risk scores and clinical manifestations was also evaluated. RESULTS: There were 16 independent single nucleotide polymorphisms (SNPs) located in 11 loci showing significantly association with susceptibility to IgAN in the Europeans. 93.75% (15/16) of them also showed significant associations in the Chinese (P<0.05). The effects of all the associated SNPs were in the same direction, either risk or being protective for IgAN, between the Chinese and the Europeans. On the contrary, remarkable higher risk allelic odds ratio (P=1.94×10-2), higher risk allele frequency (P=3.09×10-2), and higher population attributable risk (P=3.03×10-4) were observed for most of the associated SNPs in the Chinese than in the Europeans. Furthermore, genetic risk scores were significantly larger in the Asian populations compared with the Europeans (P=1.78×10-163). While there was no significance among the subpopulations in both the East Asians and the Europeans. Compared with the healthy controls, the genetic risk score in the IgAN patients was significantly larger (P=3.60×10-27). Clinical analysis showed the genetic risk score was positively associated with serum levels of IgA and IgA1, phases of chronic kidney disease and Haas grades. CONCLUSION: Our study provides further evidence in the shared genetic architecture between Chinese and Europeans, while differences with respect to the effect sizes and risk allele frequencies across ethnicities, contributing partially to the differences of disease prevalence.

Experimental Realization of Robust Geometric Quantum Gates with Solid-State Spins.

We experimentally realize a universal set of single-bit and two-bit geometric quantum gates by adiabatically controlling solid-state spins in a diamond defect. Compared with the nonadiabatic approach, the adiabatic scheme for geometric quantum computation offers a unique advantage of inherent robustness to parameter variations, which is explicitly demonstrated in our experiment by showing that the single-bit gates remain unchanged when the driving field amplitude varies by a factor of 2 or the detuning fluctuates in a range comparable to the inverse of the gate time. The reported adiabatic control technique and its convenient implementation offer a paradigm for achieving quantum computation through robust geometric quantum gates, which is important for quantum information systems with parameter-fluctuation noise such as those from the inhomogeneous coupling or the spectral diffusion.

[Relationship between one-stop CT spectral perfusion imaging parameters and expression of lymphatic microvessel density and vascular endothelial growth factor-C in axillary lymph nodes of rabbit VX2 breast cancer].

Objective: To analyze the correlation between quantitative parameters of one-stop spectral perfusion computed tomography imaging and the expression level of vascular endothelial growth factor-C(VEGF-C) and MLVD in metastatic lymph nodes of rabbit VX2 breast cancer. Methods: Thirty New Zealand purebred female rabbits were used to establish the lymph node metastasis model of rabbit VX2 breast cancer, one-stop spectral and perfusion CT imaging protocol was performed.The axillary lymph nodes were selected for corresponding image markers. The observed morphology of conventional HE staining and the EnVision method were used to quantitatively analyze VEGF-C expression and calculate MLVD.Pearson linear correlation was used to analyze the perfusion parameters of metastatic lymph node energy spectrum and the correlation of MLVD and VEGF-C expression. Results: Twenty-four experimental rabbits were successfully modeled and performed a one-stop CT scan on the 28th day. A total of 39 metastatic lymph nodes were included. The VEGF-C of metastatic lymph node was 20.0%±2.8%,and the MLVD was 12.5±3.5. There was a positive correlation between BF, AP(λHU), IC(VP), NIC(VP), VP(λHU) of metastatic lymph node and VEGF-C and MLVD (P<0.05). There was a positive correlation between lymph node IC(AP) and MLVD (P=0.027) and no correlation with VEGF-C expression (P=0.386).There was no correlation between BV, NIC(A)P and VEGF-C, MLVD(P>0.05). The correlation between VP(λHU) and MLVD was higher (r=0.448, P=0.001). Conclusions: One-stop CT spectral perfusion imaging quantitative parameters and pathological indicators have a good correlation, and it can reflect lymphatic vessel metastasis in lymph nodes.

[Application of lower abdominal aorta balloon occlusion technique by ultrasound guiding during caesarean section in patients with pernicious placenta previa].

Objective: To discuss the feasibility, effect and safety of lower abdominal aorta balloon occlusion technique by ultrasound guiding during caesarean section in patients with pernicious placenta previa. Methods: The clinical data of 40 patients with pernicious placenta previa complicated with placenta accreta from January 2015 to August 2017 in Liuzhou workers hospital were analyzed retrospectively. The study group included 20 cases, which were operated in the way of cesarean section combined lower abdominal aorta balloon occlusion technique by ultrasound guiding, while the control group also included 20 cases, which were operated in the way of the conventional cesarean section without balloon occlusion technique. The bleeding amount, blood transfusion volume, operative total time, hysterectomy and complications of the two groups were compared. Results: The bleeding amount and blood transfusion volume in study group were(850±100)ml and (400±50)ml, which were lower than that of the control group[(2 500±230)ml and (1 500±100)ml], the difference was statistically significant(t=35.624, 16.523, all P<0.05). In addition, the hysterectomy rate in study group was 5%, which was lower than that in the control group(30%), the difference was statistically significant(χ2=8.672, P<0.05). And the total time of operation was (2.0±0.5)h in the study group, which was shorter than that in the control group[(3.5±0.4)h]. The difference was statistically significant(t=11.362, P<0.05). No postoperative complications took place in the study group.The blood pressure, heart rate and blood oxygen fluctuated significantly, and the postoperative renal function was significantly reduced in the control group. Conclusions: The lower abdominal aorta balloon occlusion technique by ultrasound guiding during a caesarean section in patients with pernicious placenta previa can effectively control the bleeding during operation, and preserve reproductive function to the utmost degree.Therefore, the technique is safe, feasible, convenient and cheaper, and worthy of being widely applied in clinic.

[Application of preset adaptive statistical iterative reconstruction-V in dual-enhanced abdominal CT].

Objective: To analyze the effect of preset adaptive statistical iterative reconstruction-V (ASIR-V) on image quality and radiation dose in dual-enhanced abdominal CT and to investigate the optimal ASIR-V in clinic use. Methods: From February 13 to April 30 in 2017, one hundred and eighty patients who received up abdominal CT scan in the First Affiliated Hospital of Zhengzhou University were collected prospectively. All patients underwent arterial phase (AP) and portal venous phase (PVP) enhanced abdominal CT(120 kVp, noise index 10) and were randomly divided into 6 groups according to random number table (A-F, 30 cases in each group). In group A-F, 0-50% preset ASIR-V (an interval of 10%) was applied, respectively. Qualitative parameters (subjective image quality, diagnosis confidence and radiation dose) and quantitative parameters[image noise, CT number and contrast to noise ratio (CNR)]were measured and compared among the groups by using one-way analysis of variance or Kruskal-Wallis H test. Results: The CT dose index volume (CTDIvol) decreased with the increasing of preset ASIR-V. The effective radiation dose (ED) was significant different among groups (F=27.598, P<0.05), and the ED of group B-F dropped by 10.8%, 21.7%, 31.2%, 44.9% and 61.9% respectively when compared with that in group A. Group E showed the optimal image quality (Z=18.675, 27.548, 19.761, all P<0.05) and diagnosis confidence(Z=21.387, 17.693, 22.459, all P<0.05) in plain scan, AP and PVP phases. There was no significant differences in image noise and CT value of liver, pancreas and muscle among groups (F=1.468, 0.337, 0.592, 0.284, all P>0.05). There were significant differences in CNRs in liver and portal vein in PVP phase among the groups (F=3.980, 4.681, both P<0.05). Conclusion: In abdominal CT, 40% preset ASIR-V can provides the best image quality and it can reduce radiation dose for 44.9%.

Presence and characterization of Klebsiella pneumoniae from the intestinal tract of diarrhoea patients.

The objective of this study was to investigate the presence and characterization of Klebsiella pneumoniae (KP) from the intestinal tract. Forty-three KP strains were isolated from 551 stool specimens from diarrhoea patients from 2013 to 2016, with a carriage rate of 7·80%. All isolates were hypervirulent KP strains with hypermucoviscosity phenotype. The virulence factors and antibiotic resistance exhibited diverse distribution. 2·33% (1/43), 2·33% (1/43), 6·98% (3/43), 6·98% (3/43), 4·65% (2/43), 11·63% (5/43) and 18·60% (8/43) were identified as serotypes of K1, K2, K3, K5, K20, K54 and K57 respectively. K54 and K57 were relatively predominant. Virulence genes distribution differed with serotypes. fimH, ureA and wabG had the highest detection rates while iroNB the lowest. With the highest resistance rates to azithromycin and sulfamethoxazole of 97·67%, and the lowest to imipenem of 0%, 31 isolates (79·02%) were detected to be multidrug resistant. A significant negative correlation existed between multidrug resistance and number of virulence genes (R2  = -0·78). Forty one PFGE types had been identified among the 43 isolates and the diversity banding pattern had no relation with the drug-resistance and virulence factors. SIGNIFICANCE AND IMPACT OF THE STUDY: This is the first study to comprehensively report the presence, distribution of serotypes and virulence genes, antimicrobial susceptibility and DNA fingerprints of Klebsiella pneumoniae (KP) from intestinal tract of diarrhoea patients of China. Distribution of virulence genes, antimicrobial resistance spectrum, and relationship between virulence genes and antimicrobial resistance are clarified. It will be of great public health significance to estimate the prevalence of KP in faeces of diarrhoea patients, and to provide a theoretical foundation for the traceability, prevention and control, and reasonable treatment of infections caused by this bacterium.

[Investigation of human brucellosis diagnosis and report quality in medical institutions in key areas of Shanxi province].

Objective: To evaluate the accuracy of human brucellosis diagnosis and reporting in medical institutions in Shanxi province, and understand the performance of clinical doctors to diagnose human brucellosis according to diagnostic criteria. Methods: Field investigation was conducted in 6 medical institutions in the key areas of human brucellosis in Shanxi province. The diagnosis data of the reported brucellosis cases in 2015 were collected and reviewed retrospectively for the evaluation of the diagnosis accuracy with systematic sampling method. The database was established with Excel 2010 and the descriptive analysis and statistical test were conducted with software R 3.3.2. Results: The diagnosis consistent rate of the 377 brucellosis cases reviewed was 70.8% (267/377), the diagnosis consistent rates in medical institutions at city-level and country-level were 77.0% (127/165) and 66.0% (140/212) respectively, the differences had significance (χ(2)=5.4, P=0.02). Among the reviewed cases, the diagnosis consistent rate of laboratory diagnosis and clinical diagnosis were 87.1% (256/294) and 13.3% (11/83) respectively, and the differences had significance (χ(2)=170.7, P<0.001). Among the 21 investigated clinical doctors, the numbers of the doctors who correctly diagnosed the suspected cases, probable cases and lab-confirmed cases were only 3, 0 and 8 respectively. All of the clinical doctors knew that it is necessary to report the brucellosis cases within 24 hours after diagnosis. Conclusion: The accuracy of human brucellosis diagnosis in key areas of human brucellosis in Shanxi was low, and the performance of the clinical doctors to diagnose human brucellosis according to diagnostic and case classification criteria was unsatisfied.

Correlation between RAR-ß expression in lung squamous cell carcinoma tissues and prognosis.

OBJECTIVE: To explore the retinoic acid receptor-ß (RAR-ß) expression in lung squamous cell carcinoma (LSCC) tissues and its prognosis. PATIENTS AND METHODS: SP assay was used to detect the RAR-ß expression in 100 cases of surgically resected LSCC tissues and 20 cases of peritumoral normal lung tissues, and prognosis follow-up was conducted. RESULTS: The overall positive expression rate of RAR-ß was 54.00%, which was not correlated with age, gender, phase and pathological type (p>0.05). Stratified analysis showed that the prognosis of patients with positive IRAR-ß expression in phase I was significantly better than that of those with negative IRAR-ß expression, in which the median survival times were 31 and 22 months respectively (p=0.022). In contrast, the prognosis of patients with negative RAR-ß expression was better than that of those with positive RAR-ß expression in phase II and III A. The median survival times were 23 and 16 months respectively in phase II p = 0.008, and 19 and 7 months respectively in phase III A (p=0.019). CONCLUSIONS: RAR-ß is expressed in LSCC tumor tissues. RAR-ß expression, which is not significantly correlated with the clinicopathological characteristics of patients, affects the postoperative survival of LSCC patients in phase I and II-III A dually. RAR-ß expression state is one of the independent factors for the prognosis of LSCC patients.